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Inside Tesla’s factory, a medical clinic designed to ignore injured workers (revealnews.org)
336 points by amputect 8 days ago | hide | past | web | favorite | 403 comments





Statement from Basil Besh mentioned in article:

“I spent nearly one hour with Reveal detailing Tesla’s decision earlier this year to bring me and my medical team on site at Fremont, providing its employees with state-of-the-art occupational and musculoskeletal health care. I detailed our vision for exemplary patient care and I gave specific examples of protocol improvements and subsequent successes in outcomes in only four short months, including accurate diagnoses and reducing needless delays for advanced testing and treatment. I patiently educated Will Evans on how Tesla allowed me to give the same care to Tesla employees that I do to my private patients including ones who are professional athletes, with the ability to get necessary testing and treatment in a timely manner without being hindered by an often cumbersome California Worker’s Compensation System that sometimes negatively effects injured workers.

I counseled Will on the difference between subjective complaints of pain, which cannot be proven and are often magnified, and objective signs found only on careful clinical examination by an experienced physician. I even mailed Will a copy of a relevant chapter from the American Medical Association Return to Work Guidelines and offered to make myself available for additional questions. Research and evidence-based medicine indicate that deconditioning injuries involving sore muscles should not be treated with inactivity as this only exacerbates the problem, but should instead be treated by proactive conditioning, ergonomic modifications and supportive care. Not all patients in pain should be off work, at home and on opioids. In fact, it is most often in these patients’ best interest to have supportive care that enhances their activity, their function, and their well-being.

As a physician, my foremost obligation is to perform a careful history and physical examination, order additional tests when clinically indicated, make an accurate diagnosis, and deliver the absolute best care possible. If patients are injured and continued work presents safety issues for the patient, myself and my fellow physicians prescribe the appropriate work restrictions. Any suggestion that myself or any of my medical team at AOC allow external factors to influence our medical care in any way is false and inaccurate.

I advised Will on why ambulances should be reserved for life or limb threatening injuries and that every ambulance that is thoughtlessly called for a non-life-threatening injury is one less ambulance that is available to actually save a life rather than be used as a convenience. Most importantly, all members of my team are empowered to call 911 for any limb or life-threatening condition.

Rather than deliver an informative and balanced piece of journalism, Reveal has instead chosen to hitch its wagon to Ms. Anna Watson, a provider with whom we severed ties after less than two weeks at our clinic and about whom I cannot provide any additional comment as she is currently the subject of an investigation by the California Medical Board. Instead of highlighting the tremendous progress being made in both patient safety and patient care at Tesla, this report uses poor sourcing to tell a story consistent with a predetermined agenda.”


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.

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.

> 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

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.


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


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.


> 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).


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).


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 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.

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!

> > 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.

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.


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.

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.


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)

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

What?


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.


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?).

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.

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.


> I counseled Will on the difference between subjective complaints of pain, which cannot be proven and are often magnified, and objective signs found only on careful clinical examination by an experienced physician

If a patient has a pain in his foot, but the doctor cannot understand the pain, then, according to Basil Besh, the patient doesn't have a pain in his foot.

This seems to advocate minimizing the importance of the patient's reporting of pain. Patients are experts in how they feel, and while they may not always be accurate, what a patient tells his doctor, should be fundamental in diagnosis & treatment.


"If a patient has a pain in his foot, but the doctor cannot understand the pain, then, according to Basil Besh, the patient doesn't have a pain in his foot."

Sorry, where does he say this or are you misunderstanding and making an huge assumption that the doctor's objective examination wouldn't include ultrasound, x-ray, and/or MRI diagnostics - which would all be part of determining objective cause? For example, if pain exists in an area - say in the feet - even if there's nothing visibly broken, fractured, or torn, an inflammatory process (which causes pain in itself) will show up as extra fluid in areas where there shouldn't be fluid noticeable.


> Sorry, where does he say this

He didn't state that. That's my interpertation of his well written and very reasonable (at face value) statement. His central messages are "the doctors know best, and we shouldn't listen to patients as they are work-shy and/or drug addicts", and "I won't talk about the whistleblower, Anna Watson, except to say that she's a trouble-maker, whom we had to fire, and is being investigated for malpractice".

I'm not a medical professional, but I don't agree that machines can always diagnose pain. If a patient says he's in pain, then the doctor should take his word for it. It becomes more complicated if the patient is potentially addicted to pain medication, but fundamentally the word of the patient needs to be central in medicine.


Okay, so I agree with everything you say except for the false assertion that he's being dismissive that just because the pain can't be "proven" - that it's to be dismissed. He doesn't seem to say that anywhere.

I'll agree that he is dismissive of some of the claims, but only because I have never heard of a doctor in these situations not being somewhat dismissive. Its an interesting environment with a lot of moral hazard at a lot of companies.

I know nothing specific to Tesla's environment.


Not saying it and not thinking it are two different things. If he didn’t have an opinion on the matter, I just cannot see why he would even bring it up.

In the best case, I feel like he intents to say that even though people claim to be in pain, there’s nothing medically wrong with them, and it’s fine to send them back to work.


This is why I asked. And really, that's your best case understanding or your most skeptical/negative case of the interpretation, and without allowing for any assumptions for the full context of the scenario? Honestly there isn't enough context with what the doctor said there as to what actions would be taken and under what types of circumstances - however then people like to make wild accusations/speculation based on not enough context; sure, you can get worry and emotional at the possibilities, and state those potential worries - however assuming that the doctor's ultimate intent is to sweep something under the rug and send an adequately injured worker back to work... that's less to not reasonable.

I’m just saying the mentality of dismissing primarily mental anguish lends itself extremely well to dismissing worker complaints and sending them back to work.

Whether or not that is actually the case, as you say, is hard to prove.


Powercf is making no such assumption. You, on the other hand, are assuming two things: firstly, that medical science is actually capable of identifying the physical cause of every pain (on the contrary, ideopathic pain is widely recognized as being a problem), and secondly that the medical staff at the facility has every device and diagnostic skill (up to MRIs, apparently) to make such a determination, and would, in fact, take the time to do so before deciding how to transport a patient off the facility.

Powercf did interpret/make an assumption of something that I believe was false.

It seems a lot of assumptions are being made by everyone - or context not being controlled for enough during responses - and it's too much effort to counter it all, some assumptions more or less reasonable than others; it's reasonable that they likely don't have an MRI, more likely they have x-ray and ultrasound - more likely reasonable to assume that based on the incident itself, what happened specifically, they can determine a reasonably safe course of action.

If there was an injury at work, and pain resulting from that, it's reasonable to assume that there was just an event that occurred to cause that injury/pain, right?

Basically missing from everyone's arguments are the specific contexts of different scenarios being argued around:

If someone hurts their hand and it visibly needs care, you send them to the hospital - that likely doesn't need to happen in an ambulance unless they're bleeding out and can't be stabilized.

If someone's just walking along or makes a twisting movement that that causes them immense back pain - and say, it wasn't from getting hit by any machinery moving quickly - then that sounds more like an inflammatory response the body does to stabilize an area that just had a nerve pinched than something more potentially devastating; a doctor should be able to based on the situation described by the person decide if they need to be mobilized and taken by ambulance or if taking a Lyft would be quicker getting them to full care. Likewise, that twisting movement should then be addressed to make sure their body can handle it or that their movement is proper for the task at end - that we could assume they're repeating often.

I've hurt my back before where I was walking like a hunchback 90 year old man, where I had to walk bent over a bit to stop the pain from getting worse; it was twisting from playing floor hockey after having just before done a hot yoga class, so my body was open and muscles weren't as tight/supportive - and it was only actually the next morning when the inflammatory reaction had kicked in/stabilized the area; I didn't go to the hospital, I did however call my chiropractor who I'd been seeing for other issues who could see and access me. She used heat and laser light to help reduce inflammation in the area (which helped), and told me to rest and not do yoga for a few weeks - and suggested anti-inflammatories if I wanted to take them. I half-jokingly pressed her to let me go after a week, to which I had a followup with her, went to the same hot yoga class 6 days later - and that heat, blood flow, stretching/strengthening - completely cleared whatever inflammation/pain process was happening in my spine and I felt 100% better afterward.

If someone was hit by machinery, say in the head, your decision making process will be different then if they're just walking and sprained an ankle. We can assume that if the on-site doctors are trained well then they're making good judgement calls based on the information presented to them, based on whatever diagnostics they may have available; the fail-safe to this is however why there are organizations like OSHA, to hopefully make sure good/acceptable decisions are being made.

My biggest concern in all of this would every doctor's ability for critical thinking, including having strong situational awareness, however that would come with proper/adequate training - and that would be required for any on-site doctors, ambulance attendants, or doctors working at hospitals.

EDIT: Just to point out - there was also an assumption made that my response was talking about this doctor's response/behaviour if he was at the Tesla facility and in the context of a worker coming to them on-site at Tesla, when in fact the context was never set and I wasn't specifically referencing what diagnostic tools they may have at Tesla.


A description of how things should be, no matter how correct (or long), is not evidence that the specific allegations, of things being otherwise, are wrong.

Are you claiming that in all cases, pain can be attributed to some specific and observable physiological cause? Because that is not true at all, as many people with chronic pain can attest.

I have chronic pain that I have been problem solving for years, and succeeding in healing with stem cell treatments. I've had central sensitization and/or chronic pain syndrome (a few other terms are used as well). I'm very familiar with pain and perception of pain.

No, I'm not saying that in all cases pain can be attributed to something observable. There are different causes that can be from an immediate larger injury, to repetitive stress injuries - and likewise not excluding holistic influences, whether it being a source of pressure on nerves in the spine or even a diet that causes high inflammation in the body; different medications can certainly cause people problems too, whether increasing the sensation of pain and/or allowing them to cope until a minor injury becomes worse.

The person commenting above made a general statement that was actually wrong - they made a false assertion, saying that because it can't be objectively found (in the foot) it must mean the doctor doesn't believe it's there - when in fact the doctor simply said it can't be proven: that doesn't state whether the doctor believes the pain is there, nor what action for care would happen or recommend. If there's pain in the foot and nothing shows up on ultrasound, X-Ray (or motion X-ray), MRI - then you'd need to move up the body to see where else pain may be coming from - the spine being a stronger possibility as pain can radiate down. Likewise, as you said, many people with chronic pain can attest to there not perhaps being a physical cause - and we know that emotional pain/stress can manifest into the physical body; and because of plant medicines, higher use of psychedelics and their ability to help people reconnect and process repressed/suppressed emotions, people often report physical pain (arthritic type pain on all their joints, "heart pains", etc) going away often after one or a few Ayahuasca ceremonies, etc.

From my own experience doctors and the medical system have a really terrible understanding of pain, perception of pain. Luckily regenerative medicine (with stem cells et al) is giving options for people in pain to "experiment" - and with great success in many cases, assuming the process/protocol followed is from a research/evidence-based process (e.g. you're not getting treated by someone who only kind of knows what they are doing).


Me and my wife are personal patients of Dr. Besh. While it is anecdotal, we have nothing but positive things to say about him and his practice.

He identified a problem with my wife's thumb that was causing pain for years. He root caused it and put a plan in place in our first meeting. He was excellent, professional, fast, and very reasonable.


But you're paying him to help you. The article claims that Tesla is paying him to not help their injured workers. These are not contradictory, he can profit both from being a good doctor and not being a good doctor, (if the claims in the article are right).

Sounds to me like he confirms everything that’s said in the article...

How Tesla allowed me to give the same care to Tesla employees that I do to my private patients including ones who are professional athletes - With that I'm almost certain he is lying or full on marketing mode rather than truth. But that just the cynical me maybe.

Yeah I'm sure that if Steph Curry had a car trunk fall on his back and couldn't walk, Besh would send him to the hospital in a Lyft instead of an ambulance.

What about a self-driving Tesla ?

Too many emergency vehicles near the hospital for it to slam itself into at high speeds.

"I advised Will on why ambulances should be reserved for life or limb threatening injuries and that every ambulance that is thoughtlessly called for a non-life-threatening injury is one less ambulance that is available to actually save a life rather than be used as a convenience."

What a load of absolute garbage. Shame. There are plenty, PLENTY of ambulances to go around. This isn't some wartime situation where medical care should only go to those about to die.

A few years back my wife had a back injury that prevented her from walking. We called an ambulance, and it was the best decision both according to her (who couldn't move) the ambulance paramedics, and the doctors at the hospital. Her injuries WERE NOT LIFE THREATENING, but she still required an ambulance to transport her without further injuring her back and potentially causing paralysis. Again, not life threatening, just paralysis - no big deal right?

Basil Besh should step down from whatever position they hold.


You're talking about a situation that justifies calling an ambulance. You're probably not qualified to assess the injury, your wife could not move and had an acute injury. The article is describing medical professionals in a clinical environment making medical judgement calls.

Most workplace injuries are not emergencies. Even the example given of a broken hand is not an injury that is helped by an ambulance ride, if anything you are delaying treatment by calling 911 and waiting for an ambulance to be dispatched for a very low priority injury. Most companies have a policy of calling 911 only to avoid liability -- they care more able getting sued for the result of a car accident on the way to the hospital than the employee. In this case Tesla has medical personnel on site who can make subjective judgements and do so with their license at risk.

The other thing being missed is once you're admitted to the hospital for a workplace injury, you're stuck in the Worker's Compensation system and end up in a kafka circle of bureaucracy where as an employee you end up wasting alot of time and potentially alot of money as the insurance companies, independent doctors, etc all fight over pennies.

As far as "there are PLENTY of ambulances to go around" that often is not true, especially when you're talking about a big workplace like a factory where getting in and out will take a long time. My brother is a fireman paramedic who gets bullshit ALS calls all of the time. It's really frustrating when September comes and people in car accidents or serious injuries are left waiting because some panicked coed calls 911 for a passed out drunk friend who is "dying, I don't think she's breathing" every Friday.

I'm no Tesla fanboy, if you look at my comments I'm often harshly critical of them. But IMO this is an article on a boring topic that nobody understands that is ginned up and novel because we're talking about Tesla.


I definitely agree with this, especially the last paragraph. I feel like a lot of people responding to this have never really talked to factory workers. There is a lot more ambiguity here than they seem to realize. Unfortunately there is a lot of moral hazard here as well.

"Even the example given of a broken hand is not an injury that is helped by an ambulance ride, if anything you are delaying treatment by calling 911 and waiting for an ambulance to be dispatched for a very low priority injury"

The thought processes of some of you genuinely scares me. What happens if the person goes into shock from the pain and loses consciousness in the taxi? How the f do they even put the seatbelt on, if their hand is broken? What kind of small talk will the Lyft driver make with them? "Is that a piece of bone I see peeking there you naughty naughty boy!"


I don't want get too involved in this discussion, but in the medical sense, one does not simply "go into shock from the pain". For shock, there needs to be some mechanism that is interrupting the circulatory system and preventing proper blood flow to the tissues of the body[0]. Sure, that mechanism could be something that also causes one to go unconscious. It may be also be an "Acute Stress reaction" [1], and it does not seem to involve a grave threat to the circulatory system. It's psychological. Note: I am not a doctor, and anything I've said here should not be misconstrued as medical advice/diagnosis. I've simply taken a first-aid course.

[0]https://en.wikipedia.org/wiki/Shock_(circulatory)

[1]https://en.wikipedia.org/wiki/Acute_stress_reaction


Most people have two hands, and in a pinch can buckle themselves with either. Anyway, the driver or a coworker/onsite medical staff can buckle them in as well.

If the person loses conciousness on the way to the hospital, the driver can either call 911 on the way and arrange a transfer to the ambulance or just pull up to the emergency room and yell / honk / go in to get help getting the person out. Hopefully the onsite clinic would call ahead so that the ER / urgent care knows what to expect.

If the patient is in fairly stable condition, and it's quicker to get them to the hospital with a taxi than an ambulance (because of ambulance priorities), it seems prudent to take a taxi.

I see further in the thread that an ambulance was denied for a back injury, which seems less prudent.


Driver is likely not to notice the passenger is unconscious. I completed well over a thousand rides and many of them were with passengers who did not interact with me. Once they are in the rear seats, I do not observe them. Looking at traffic keeps me busy enough.

Driver has no duty to alert ER staff or arrange supplemental transport.

Lyft and Uber could offer medical transport service at an appropriate rate where the driver would get trained and tasked with additional duties.

Navigating into Tesla factory from the freeway takes time. Most drivers will get pinged from the freeway. Unless the driver has been to that facility many times, finding the right pickup point on any large corporate campus is a challenge.

I have transported several people to ER. Those were demanding rides due to elevated risk of passenger causing damage to my car.

Ambulance priority - patient stability Rideshare priority - no damage to the vehicle

As you can see, they are not aligned.


Are they alone all this time? Why would they be alone in the car?

The same thing that happens to a person who is sitting in an office chair waiting 90 minutes for an ambulance to be dispatched for a low-priority injury.

For a serious injury, the right thing to do is call 911, describe the situation, and let them make the call whether to use an ambulance or private transport. Tesla doesn't want the 911 call because it creates a paper trail for injuries they don't want to report, and because they're desperately low on cash. Part and parcel with the culture of deception at that company.

I think you can probably replace the name of the company in this article with anything and people would still be outraged.

Really?

~30 people, including several employees have been killed by private garbage haulers unsafely operating in NYC since 2014. That's a pretty serious workplace safety problem that affects the public, but lacks the Tesla clickbait factor and associated hand-waving.


> The article is describing medical professionals in a clinical environment making medical judgement calls.

The article describes medical professionals making medical judgment calls, and getting censured or fired for it.


>The other thing being missed is once you're admitted to the hospital for a workplace injury, you're stuck in the Worker's Compensation system and end up in a kafka circle of bureaucracy where as an employee you end up wasting alot of time and potentially alot of money as the insurance companies, independent doctors, etc all fight over pennies.

This is very strange advice. It sounds like you’re arguing that when you’re seriously injured at work, you shouldn’t seek appropriate medical care.

That’s the kind of right out of The Jungle isn’t it?


Neck and back injuries are a good reason to call an ambulance. The original quote refers not just to life but "life or limb". I suspect any reasonable person would extend that to "paralysis". Back and neck injuries often render a person immobile (as you say, for risk of further injury).

Your anger seems grossly misplaced and based on a deliberate misreading or uncharitable reading.


See my other replies, Tesla denied ambulance service to man with a severe back injury, unable to walk.

Are you really willing to believe that if the medical doctor thought and ambulance was required for the supposed injury, they will choose to have someone die on their watch, with full legal liability for the death. What do you think the doctor has to gain by arranging other no ambulance medical transport here.

The doctor was taking a calculated risk that whatever care the worker didn't get, as a result of taking a ride share instead of an ambulance, wouldn't kill him. Keeps Tesla's ambulance costs and trip numbers down.

>What a load of absolute garbage. Shame. There are plenty, PLENTY of ambulances to go around. This isn't some wartime situation where medical care should only go to those about to die.

And your response is some anecdotal story about calling an ambulance when it wasn't really needed?

Do you think ambulances (and trained medical professionals to staff them) come in plentiful supply?

Do you know that many people die every year waiting for an ambulance and due to ambulance non-availability all around the world?

  “It’s shocking how close or how often the ambulance level 
  gets to ‘Level Zero’ or close to ‘Level Zero.’ What this 
  means is there are no ambulances left in the city,” 
  Joseph Ross told the committee.
https://www.nbcsandiego.com/news/local/Medics-and-EMTs-Lack-...

https://globalnews.ca/news/3995973/hamilton-code-zero-ambula...

https://www.boston25news.com/news/someone-is-going-to-die-25...

https://www.npr.org/sections/health-shots/2017/04/11/5230259...

https://www.cbc.ca/news/canada/new-brunswick/david-harvey-de...

https://www.pressreader.com/south-africa/daily-dispatch/2018...

https://www.bmj.com/content/321/7270/1176.2

https://www.theguardian.com/society/2018/jan/18/ambulance-cr...

https://www.theguardian.com/society/2018/mar/31/ambulance-cr...

https://www.theguardian.com/society/2017/dec/17/alarm-sharp-...

>Basil Besh should step down from whatever position they hold.

Perhaps, but not because of an ignorant rant.

Note also that Basil mentions "life OR LIMB threatening" -- not just life threatening. And that can easily include risk of paralysis...


> And your response is some anecdotal story about calling an ambulance when it wasn't really needed?

I think you missed the point. My anecdote was meant to outline how the ambulance WAS really needed despite my wife not in a life threatening situation.

Back injuries are very, very, very serious. I spent a few days considering the possibility that my wife wouldn't ever walk again. If someone even suggested we took an ambulance needlessly I (and the doctors treating my wife) would have gone ballistic. I'm checking out from this thread as it's clearly effecting me emotionally.

>Do you know that many people die every year waiting for an ambulance and due to ambulance non-availability all around the world?

We're talking about Nevada, not the world.


>We're talking about Nevada, not the world.

Well, I gave examples from Boston, California, and elsewhere. And it's not like parts of Nevada fair better:

  Despite such efforts, the shortage of medical 
  professionals is so serious in the Esmeralda County town 
  of Goldfield that 32-year-old Danie Johnson and her 55- 
   year-old mom, DeEtta Sligar, run a volunteer ambulance 
  service for the town’s roughly 300 residents.

  With no medical clinic in town and the nearest hospital 
  more than 110 miles away in Bishop, California, Johnson, 
  Sligar, two other EMTs and four drivers spend hours at a 
  time ferrying ill residents across the border. They 
  receive $132,058 a year from the county to keep their 
  ambulance and an old backup running.
That's par for the course for rural places everywhere. But ambulance shortages are there even in the biggest of cities (it's matter of state recourses and proportion of ambulances and medical pros to the population, not an absolute matter of population size).

It's not a shortage of ambulances but more an issue of not having any hospital in a 100 miles radius.

The article says life or limb. You keep taking out limb and talking about your wife’s back. That seems dishonest to me at best.

It's not dishonest, it's just irrelevant.

If your friend fell off a ladder and hurt his/her back in a way that prevented them from moving, what would you do? The chances are that you don't know how to assess that injury. It's prudent for you to call 911 and have an EMT and/or Paramedic assess and make the call on the next action.

It's different if you are a doctor, working at a factory, and have an injured employee brought to your infirmary.


Read the article again, focus on the part about Stephon Nelson.

And his point is that "Limb threatening" covers back injuries as well. You're being disingenuous implying that your situation was the sort of thing which the Doctor was advocating not using an ambulance for when he's said nothing of the sort

The problem is a shortage of EMTs, not that people are abusing the system and calling ambulances for no reason.

Given bounded resources, there might always be a "shortage of EMTs". Some rural places for example don't have the funds to even support one (and an a couple of emergency situations can peak demand even in bigger cities).

The shortage might be at the root of the problem, but it also might be unavoidable. It's not always a given that a shortage can be fixed (or when it will be fixed). And given a shortage, people who call ambulances for no reason (which very much exist) make things worse.


Totally agree with you. The thought of someone advising another person on whether or not to use an ambulance when they ask for one is unimaginable. Maybe there are some people that abuse the system, but I think the overwhelming majority of people know when to call an ambulance without having to be advised on it. Either there are some hardcore Tesla fanboys on this forum or seems to me there might be some Tesla PR going on here, don't know what to make of some of the comments and of course can't prove where they originate from.

Even in this context of a it being doctor advising another person?

I knew an EMT who called himself a "Medicaid chauffeur". Said people would call for headaches. The thought of NOT advising another person on whether or not to use an ambulance when they ask for one is unimaginable.

> The thought of someone advising another person on whether or not to use an ambulance when they ask for one is unimaginable

You literally can't imagine a medical doctor, responsible for the patient in question, advising on whether an ambulance is indicated or not? Because that's what you appear to be saying.


I feel you're being kind of disingenuous here ignoring the "and limb" part of his "life and limb" statement.

It's quite clear Basil would be calling an ambulance in your wife's situation - as there was significant risk in additional injury (the "limb" part of his statement) if not otherwise done.

Knowing medical professionals who actually work in the ED overuse of all emergency services - including ambulances - is embarrassingly common.


“I couldn’t walk, I couldn’t sit down. I couldn’t even stand up straight,” said Nelson, who’s 30 and used to play semiprofessional football. He asked for an ambulance, but the on-call Tesla doctor said no – he could take a Lyft to the hospital instead."

Sure about that?


Actually, according to the article they didn't want to call an ambulance for someone that couldn't walk, sit or stand straight (Stephon Nelson).

It's sad that we're debating whether an ambulance is needed for people with back injuries or mangled/broken fingers.


Hi horseRad,

Do you have a citation/source/link for statement?



Thanks zaroth! I appreciate it.

Where can this statement be found?

>"Not all patients in pain should be off work, at home and on opioids"

>“And when we told them, ‘No, we really want to do what’s best for you’ … it’s taking some time to get buy-in.”

How fortunate Tesla employees are to have somebody making the unpleasant decisions to save them from becoming heroin addicts!

Also, this sounds like something my grandparents would say about life in the USSR:

>“I have spoken again with (the workers’ compensation official) at Tesla and he informed that the forklift did not have electric current running. With that said, in my medical opinion, the patient does not have an industrial injury attributed to an electrical current,”


Funny how this thread is debating whether a crushed hand or severed fingers justifies an ambulance or ride share.

It is illegal for “ride shares” to provide medical transport. The fact that an on-site physician would not call medical transport and put patients with crush hands/severed fingers in a ride share is per se illegal.

Next we will hear the “SV disruption cult” begin making their claim that those regulations only exist because the EMT lobby industry is spending billions for legislation to protect the market incumbent. Well don’t forget your extra $150 Uber cleaning fee for bleeding all over your drivers car.


From a European point of view, this whole thread is surreal. Your hand is crushed or your fingers are severed, you are sent to the ER in an Ambulance.

This is impressive how far the US has normalised the concept that health is primarily a financial decision. Especially in the HN bubble that consists mostly of wealthy individuals.


From a USA standpoint the thread is almost as surreal. You either call an ambulance or drive them yourselves. At no point would it ever come up to send them in a taxi where I work.

Now depending on the issue it is faster to drive/be driven from where I work so an ambulance is often not that useful. For example a while back a coworker ate a tamale off the food truck only to find out that it contained peanuts. After noticing the reaction the owner took him to the ER personally (Coworker used his epipen as soon as it was known he needed it.) It is ~8 mins by car and at best an ambulance would have been 6 here and 6 back for an arrival time of 12 minutes. Now had they not been breathing they probably could have gotten a fire truck here in 2-3 mins to administer some epinephrine but they would still have had to wait the same 12 minutes to make it to the hospital because the fire truck EMT's can only do on site treatment.

So unless it is extremely dire taking a coworker to the hospital can be faster than an ambulance. That said a crushed hand or cut off finger? That is one of those where seconds matter and the fire truck/ambulance combo would be used.


You're lucky and probably in a cushy white collar gig.

My uncle worked for a place where a vendor CE had a heart attack and died in the early morning in a raised floor space control room. Someone called 911 multiple times and due to bureaucratic fuckery security didn't let the EMS in multiple times. In short, the dead guy was wheeled back and forth by operators for 12 hours, when the plant manager dropped in and lost his shit and took care of it.

Like I said somewhere else, this topic is a corner of the world that sounds insane if you're not in it.

Where I work, 911 has no idea where we are for reasons, and a serious incident where a person isn't vocal requires a floor sweep. The emergency services don't have the time or interest to handle your company's internal stuff, particularly if you have a high call volume.


Pretty sure an electronics tech for a small machine shop (20 employees or so) does not count as white collar. Some days I envy coal workers. At least their stuff is dry unlike the atrociously bad coolant and grease I am often in.

> That said a crushed hand or cut off finger? That is one of those where seconds matter and the fire truck/ambulance combo would be used.

Unless there is uncontrolled bleeding that is definitely not a "seconds matter" situation. Sure, you want to get to a surgeon sooner rather than later, but an extra 5 minutes isn't going to matter.


How do you suspect fingers become severed? As if intentionally with surgical precision? Or by more violently messy and accidental means? Do you think only a trickle of blood comes out when one of your whole digits becomes separated from your hand? How certain are you that "5 minutes" isn't going to matter in most cases? And how certain are you that in most cases there won't be "uncontrolled bleeding?"

Where do you even begin to make that sort of claim?


Fingers that are torn or crushed don't tend to bleed much, in my experience. The ragged edges of the injury site make for quick clotting.

So true! Since I follow US politics more closely (2016, roughly), I realize how damn good life is in Europe for the average joe.

I just skipped through the comments, and the fact that hardly anybody points out the fact that an employer should care for his employees and follow all applicable regulations is mind boggling.

But it could also point to a general issue regarding SV and SV-style disruption. Build a business around ignoring existing regulations, because of disruption.


It's an extremely selfish country. Some people are less than others and deserve less is exactly the mindset in USA now.

HN appears to have a more highly paid engineer out-of-touch with financial reality user base, it's not everyone, and I don't think they're doing it on purpose, but it's certainly noticeable. Even on my barely-enough-to-live wage in Seattle it's tough to not find myself forgetting the struggles of people lower in class than I. Workers rights are not popular here, and I'm guessing it's because engineers and higher paid people are often treated pretty fairly and have workplace freedoms the rest of the workforce could only ever imagine in their dreams.


True that. I dis not mean that people think likevthat on purpose. For me, I can now appreciate much more what previous generations did in Europe regarding workers rights and civil rights. I took all of that more or less for granted in the firsz world, but it isn't. No suprise back the day these fights has to be litterally taken to the streets. I'm happy people did that.

Also zrue that a person tends to stay in their own social bubble, I do it myself. Lucky me I don't have to worry about money most of the time. But that doesn't mean that you cannot be aware of others that are not in that situation. Not that I care about that often enough. Again something I realized lately.


> I just skipped through the comments, and the fact that hardly anybody points out the fact that an employer should care for his employees and follow all applicable regulations is mind boggling.

Bear in mind that europe also has 10%+ unemployment.


Unemployment rate in Europe is at 6.8%. Spain and Greece are the only countries above 10% with 15.2% and 19.1% respectively. Both countroes have been hit hard by the 2008 financial crisis, especially Greece got screwed by everyone.

Major countries close to 10% are Italy and France with 9.7% and 9.3%. That, obviously, is not good. The country that surprised me was Germany with 3.4%. No idea why this is not celebrated more, I wasn't aware of that number until now and I live in Germany.

What is worrying so is youth unemployment of people between 15 and 24. It is roughly twice as high as the rates mentioned above, in Italy even three times as high. I considee that to be extremely dangerous for a society.


There are several ways to cut it and I admit I made a sweeping statement. There is high variation with youth and country as you mention correctly, but in all ways it has a higher level of unemployment. And I concurr, the really high youth unemployment is going to be a wreck: these people will get to later ages with no savings, no investment and lower skills.

Your post made me want to go deeper in german and came across an interesting bit: german has a very low minimum wage, and also some antics around the lower eschelons. https://www.quora.com/Why-is-the-German-unemployment-rate-co....


Yes, the points in the Quora-link are valid. Also something everyone with an extreme political position is using to dismiss the official unemployment rate.

That bein said, this is a terrible thing to do to people if you ask me. And maybe not doing it and having higher unemployment would be more humane. But I'm no eypeet, just a guy with an opinion.

Also, out of experience, in Germany you are not officially unemployed if you are in a training program sponsored by your oocal unemployment agency. Also a nice way to optimize your numbers. And the explanation why there is a whole industry built around just these trainings.

When Germany introduced all these thing back in the early 2000s, it was tough. Germany was called the sick man of Europe. Maybe, these initiatives, Agenda 2010 it was called, were not totally wrong. Downside was the creation of whole class of people that aee basically stuck at the lower ranks of the social ladder. So, good for the economy, yes. Good for the country maybe. Good for society, I would say no.


All good comments. My original and main point is that there is a trade-off between the high-protection for workers and unemployment levels. My own home country boasts worker's rights constitutionally but has 30% of poverty level and 50% of child poverty. 40% of the population is not covered by the "worker's protections" because they are not employed.

Highest income workers always get the benefits of workers perks first, and this is unavaoidable. Look at google, famous for giving benefits to employees like good, gym, juic etc, but buildings maintained by swathes of contractors that dont have access to these services.

The more of these you pile up, the bigger the divide.


There's nothing American about not using ER/Ambulance services. FYI - the employee still keeps his rights to call 911 on his own volition.

This is in no way a defense of Tesla's on-site medical facility's policy of not calling 911 without authorization, but the location of Tesla (U.S.A) is not somehow responsible for draconian policies, nor is it fair to assume that if Tesla operated in the EU, such policies wouldn't exist.

FYI - from the way the article paints it, Tesla's policies are in clear violation of U.S. law.


Normalization has nothing to do with it. Americans at large didn't choose this, nor are we comfortable with it, we're simply stuck under it with no perceptible solution to it and we have to accept the financial consequences of medical choices because to not is to invite bankruptcy.

> under it with no perceptible solution

It’s to vote, convince and then copy the model from every other 1st world country... super hard sure but perceptible


Or apply the ideas used in all other markets in the same country that work incredibly well.

Oh so "just adopt universal healthcare," it's so simple, I can't imagine why no one's attempted it.

Here people refuse ambulance rides in some circumstances because as soon as they take you somewhere it's $2-3000 dollars. Bonus injustice: emergency medical technicians are generally poorly paid. I have a friend who works as an EMT trainer because he can't afford to live on what he'd get paid if he were actually working in an ambulance.

It's the way USA rations healthcare. I've had serious knee injuries from biking this summer that I had to decide to just 'walk off' because I don't have the finances to go to a doctor, get an MRI/Xray, potentially more tests. My knees are probably screwed for life now. I feel like a good portion of the USA is going to be deformed because they can't get quality health care or avoid it at all. It's really weird having to decide that your finances and rent are more fragile than your health.

My insurance for an ER visit would be roughly $4500 right when I walked in, or they wouldn't cover anything. Every time after that though would be $300 until next year when I'd have to pay $4500 again.


Reducing health care costs should be the #1 priority in america. Whatever achieves that will make drastic changes for the better in both incomes and quality of life. It is the KEY issue.

There's unfortunately no consensus on how to solve it.


From a cost stand-point, an ambulance ride in the US might be 10x the cost of an ambulance in european countries. At that price point some decisions start to become serious trade-offs.

Precisely, I mean for sparsely Trainer personell it’s Not Even allowed to give Aspirin because some people are allergic to it.

This is what libertarian and 'eliminate regulation' types want.

Human life isn't worth anything if the people can't use legal means to protect themselves.

For these US citizens (SV elite), healthcare is akin to a status symbol or a luxury that only rich people or people bestowed by the rich (think: employment) should be able to attain.

And then look at how much hatred there was when Obama tried to implement the Heritage Foundations plan, which was done by Mitt Romney in Massuchusetts. Republican, btw.

These people really don't care about the "rest of us". That's why Trump was elected. He showed he had the similar hatred and focused it. Don't get me wrong- he's done horrible for the US... But that's why.

EDIT: I would love to hear a description why I'm wrong. I've lived through the creation of Obamacare, my diabetes T2 diagnosis under it, and now the structured destruction of it, along with trying to eliminate 'preexisting conditions' exception. In short, if they get their way, I'll be dead sooner. Like 10 years sooner. Lack of health care + diabetes = death sentence.

But in the end, having us "dead weights" dying isn't a bad thing when you boil us down to $$$.


I'm perplexed by why you think the SV elite voted in donald trump to keep the dirty masses down. Perhaps you should look at a county-by-county electoral map some day.

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


> This is what libertarian and 'eliminate regulation' types want.

False. Healthcare is not a human right, but the insane inflation of healthcare costs would be avoided by removing a large portion of the regulation surrounding it. If hospitals actually had to compete to get patients, based on affordability, among other factors, healthcare would be far cheaper, and private charity/need-sharing would take the place of insurance.


That's not true. Healthcare has always been expensive. Even before regulations. Hundreds, even thousands of years back. The same regulations you're whining about made snake-oils illegal and other quacks from practicing on people who don't know better. The good old days of unregulated healthcare... Google "doctors agree cigarette" and look at the Images. See all those ads. Those ads that cigs are good for your health and infants. Yea...

Back when people thought that healthcare should not be regulated.

Now, there's a lot of fuckery in the healthcare industry. A lot. Both, business side and gov side. Both are to blame. But just saying regulation is flat out bad. That's stupid. There are many issues and each have to be addressed.

Not just a one MAGIC PILL solution.


False, healthcare is a human right

False. Healthcare requires care, as in, labor. A right to someone else's labor is a right to enslave. Healthcare is about the most sugar-coated version of it imaginable, but it doesn't change that fundamentally the "right to healthcare" is the right to force others to take care of you.

Or, it’s an obligation on society to organise in such a way that healthcare is provided to anybody who needs it by whatever means you like. Taxes, charity, whatever else. Obligations are not per se unethical - the most basic one being not to cause harm to people in carrying out whatever you’re doing, but there’s many others - and current society uses taxes to ensure that their obligations are fulfilled, but there’s other options too.

>A right to someone else's labor is a right to enslave.

And yet there is a Constitutional right to a lawyer in most criminal cases if you can’t afford one. I can assure you, while public defenders might not get paid well and maybe many can’t afford their student loans, they are not slaves.


The slaves are the tax payers in your analogy, because they pay for the public defenders.

But that case is more defensible: the enforcing of the rule of law is powerful for freedom. So sacrificing some freedom to get a lot of freedom is an easy case.

Health services do not relate to freedom, but to the cost of insurance. If the government can provide a cheaper healthcare then it should provider a cheaper healthcare, and citizens can choose the government's plan and it will eat out the competition.

Why would the government need to ban the competition if its so good at providing insurance?


> Why would the government need to ban the competition if its so good at providing insurance?

In no country ever is private healthcare and competition banned. There is a free* hospital across the street from me and I have private healthcare.

It’s about acknowledging that a) it is cheaper for everyone if people with no money go to the doctor early, because a GP is 1k% less expensive to society than a hospital bed runout. This is one of the reasons healthcare in single payer countries is ~50% per capita.

B) people without money don’t deserve to die because they are poor and should have basic treatments, even when it is their own fault they are poor and make bad decisions.

* I pay tax which pays for the hospital


> In no country ever is private healthcare and competition banned. There is a free* hospital across the street from me and I have private healthcare.

Thats not factually true: there are many places that ban private healthcare, including canada. Then there are other conditions that punish private disproportionately: like funding public healthcare with taxes, but private healthcare with private funds: that means a person would have to pay 2 insurances to get private services. Also single payer really means there is only 1 insurance, so yes, it bans all other insurances.

> It’s about acknowledging that a) it is cheaper for everyone if people with no money go to the doctor early, because a GP is 1k% less expensive to society than a hospital bed runout. This is one of the reasons healthcare in single payer countries is ~50% per capita.

There are multiple issues why healthcare in the US is more expensive than "single payer systems", and preventative medicine is a small part.

> people without money don’t deserve to die because they are poor and should have basic treatments, even when it is their own fault they are poor and make bad decisions.

Is this moral line of yours defined by the country? Because if you want to save people's lives, single payer systems are very expensive. Its a lot better to open immigration and bring poor people from abroad.


Even the right to life and liberty requires the government to have people work at jobs to maintain security. Other than an-caps, even the most rabid libertarian thinks the government should provide national security.

Isn't that all forced "slave labor" by this same argument?


This is an unrealistic absolutist argument in any realistic view of the modern world with actual governments especially given the extreme excess of resources on earth to provide everyone with good medical care.

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care…”[1]

[1] Article 25 UN Declaration of Human Rights


The right to acquire it or the right to get it from someone else?

The right to it even if you are mentally ill, broke, bad at decision making or all of the above.

My point is definitely that you have an obligation to provide society funding for healthcare even if they don’t pay. Just like the military will defend them even if they don’t pay, or a firefighter will put out their house.


> The right to it even if you are mentally ill, broke, bad at decision making or all of the above.

The right to be provided something is the right to take from someone else. There is no escape to this, its a right that infringes on the right of others.

Theft cannot be a human right, and i would strongly reject anyone that defends such a thing, including the UN.


I understand now, when firefighters save homeless people, the homeless people are stealing from others.

This thread is going nowhere, you clearly value money more than the health of people less fortunate than you. Systemic poverty and sick people, who cares right.


I value liberty above everything else, partly because without liberty everything else also goes away.

You mention a trade-off with money and health, but the very idea of taking from some to give another is a violent expression. You might justify to yourself that is fine to rob and murder for the sakes of others. Others will think the same way.


Liberty for privileged people like yourself not born with disability or systemic poverty. Thanks for proving my point.

I’m no longer participating in this thread, and won’t read any replies.


Hot dog, there's a cheaper ER 30 minutes from here!

I can certainly imagine situations when I would choose waiting another 30 minutes over paying an extra $10k... Can't you?

Ooh, THIS one reuses sharps and passes the savings on to me!

Yeah, but this one provides free mosswort and radium supplements with all limb reattachments!

Communism would have all ERs equally shitty and expensive [to the taxpayer]. Is that all that better?

I mean, your argument holds true for everything. And yet, look around us and compare to any instance of communism on various extents. Capitalism is always better.


> I mean, your argument holds true for everything. And yet, look around us and compare to any instance of communism on various extents. Capitalism is always better.

Modern mixed economies are better, but there is a reason capitalism as a system (rather than a component of another system) died sooner than Soviet-style communism, to the extent that we now unironically call mixed economies with large socialized elements “capitalism”.

Among mixed economies, it's not the more strongly capitalist ones that have the most efficient, effective, or publicly popular health care systems, either.


You can stay off our communist roads then.

Enjoy bartering and purchasing your way across private property to something distant. (Yeah, fat chance you actually hold to your criticisms.)


Bartering? You dont need to State to exchange money :S

This is a very cool dichotomy you've presented me with.

Damn this was a crude comment.

I can't imagine a human right more fundamental than health care. What good is freedom of speech or assembly or trade to a dead person?

Patients in distress are usually not very able to make distinctions between hospitals based on pricing or really any other factor apart from perhaps proximity. This key point seems to not be addressed by any of the standard libertarian takes.

Edit: Also, I grew up in a country (India) where healthcare was definitely part of the market economy. And what that meant (and still does) was that people with money get high quality immediate care, and those without get shafted. That's what the market does to healthcare.


Oh, they do have a choice:

Pay up for the nearest facility, IF you have the funds to do so.

Or die.


> False. Healthcare is not a human right, but the insane inflation of healthcare costs would be avoided by removing a large portion of the regulation surrounding it.

....So it can only be for the rich.

Insurance is simple - you have a group pool their risk together so that everyone's protected.

Yet, when we try to discuss making an insurance pool the size of the country, for everyone, people like you go all "not a right".

When I see "not a right", I read into it as "Fuck you I got mine".. when there is plenty to go around for everyone.

> If hospitals actually had to compete to get patients, based on affordability, among other factors, healthcare would be far cheaper

Citation needed: prices are NOT linked to how much thing is, but how much the market will bear. Stating falsehoods to cover up your intent is disgusting. We know how c(r)apitalism works. We're rejecting that. Tried it, didn't work. Reiterating for better.

> private charity/need-sharing would take the place of insurance.

Uh huh. So non-christians need not apply? I know how this plays out... This is a citizenry issue, for the whole country. And you end up wanting to make it a fractured "small group" issue. People fall in cracks, and you don't care. Some "mythical" group will fix it.


> This is what libertarian and 'eliminate regulation' types want.

This statement is incorrect. Libertarians want competition in the emergency medical transport industry. If someone can offer a better service and at a lower cost, then that service should be an option.

All other things being equal, if it takes an ambulance 20 minutes to arrive on scene versus a ride share that takes 5 minutes, which is preferred? Granted ambulances provide more than simply transporting someone to a hospital, but those services could easily be applied under legal alternatives and done in a safe, effective, and efficient manner.

The libertarian argument is that it should not be illegal to let the market provide alternatives.


> It is illegal for “ride shares” to provide medical transport.

Really? A couple years ago I brought my buddy to the hospital in an Uber and he was pretty close to dying, nobody at the hospital seemed to have any issues with it. I later emailed Uber to praise the driver and they thanked me for the writeup of what happened and said they distributed it on their internal listserv. Definitely did not feel like anything illegal was happening throughout process.


> A couple years ago I brought my buddy to the hospital in an Uber

In your role as on-site physician for a corporation?


> nobody at the hospital seemed to have any issues with it.

this might be because they had more important things to attend to, like your dying friend.


I don't think it is illegal, or at least I couldn't find anything saying it was. Here are three articles I found, and I'd assume at least one of them would have mentioned the legal trouble. Maybe I missed it?

    https://slate.com/technology/2018/02/when-should-you-uber-to-the-hospital-and-when-should-you-call-an-ambulance.html
    https://www.webmd.com/health-insurance/news/20170515/uber-lyft-er-trips#1
    https://www.rewire.org/living/uber-emergency-room/

It is illegal for a medical practitioner to send someone to the hospital in a non-medical transport.

As a physician, I can say that is not true

I would asume that depends on the circumstances? In an dire emergency you take the first ride you get. Otherwise I could image that there are some rules in place.

Strictly speaking, that's not true:

https://www.usatoday.com/story/tech/news/2018/03/01/doctors-...

With Uber Health, a doctor can send an Uber to pick a patient up to transport them to the doctor's office, and many doctors have offices in hospitals, so this service would then be illegal according to you, but it isn't.

What you probably meant to say is a medical practitioner can't call a non-medical transport for a patient in an emergency, which also doesn't seem true, but I can't find any articles that directly say that (why would someone write such a thing?).


It is always legal to provide help and transport, but it is often illegal to provide any treatment, and specifically avoid providing any kind of painkiller. Never. This is very important.

I wouldn't rely on Uber of all companies (esp. a few years ago) to let you know when they did something illegal…

Lyft and Uber are used by patients to go to the hospital and other doctors very regularly. I think that your idea that this is illegal is pretty novel.

Whether that should have been used in the cases described in the attached article is a reasonable debate. I'm more confident in the people on the ground making this choice than the news reporter.


Private Joe Citizen can take a taxi wherever they want (like how I took a cab to an urgent care a couple years ago after breaking my ankle in a bike accident).

Medical practitioners, however, cannot send someone in a cab. It's a huge liability issue for them. If someone is injured and needs medical transport, they need to use proper medical transport. This is what Tesla is accused of violating. Their on-site nurses are licensed medical professionals. It's worlds different from random person taking a cab to a hospital.


Really sounds like that needs to be changed then. As long as healthcare isn't socialized, you shouldn't have to be stuck with an ambulance bill for a broken foot because some outdated regulation says you can't be given an Uber instead.

I take issue with your seemingly glib dismissal of the transfer of risk to rideshare drivers - Ambulances exist for medical transport, and frankly should be used in most cases, especially in a medical transport setting. The core problem lies with the healthcare system and the pricing of ambulance services, and not necessarily with the decision to use an ambulance per se.

The law doesn’t say if you have a broken foot you have to take an ambulance to get treated at the ER.

State law regulates drivers, medical transport is a subsection and medical transport is further broken down into emergency transportation and non-emergency transportation. What the law says is you can’t just start offering medical transportation services to the public in exchange for money without complying with the law/regulations.

Further, as you might imagine doctors are regulated, and if you are treating a patient who needs to be transported to an ER for emergency services, the doctor should understand a Lyft/Uber isn’t the appropriate standard of care and is per se illegal under those facts. The doctor may have had his/her heart in the right place be not calling an abmbulance to reserve that for a hypothetical life/death patient, but it’s hard to argue this isn’t an emergency when your a doctor sending your patient to the ER, at which point emergency medical transportation laws/regulations apply.


I'm in Canada so not covered by the same laws as US states, but a few years back i went to my gp with what he quickly diagnosed as a life-threatening blood clot. He explicitly stated "i don't think we need to call an ambulance but you need to go to ER immediately". He gave me a note for the triage nurse to expedite admitting and i was into the ICU within the hour.

My wife drive me by nothing stopped me from using a taxi or ride share.

Doctors definitely have a duty of care that must consider emergency transport, but it's be surprised if laws explicitly stated you need to call an ambulance for stable patients that need emergency treatment.


If it is state law - and I suspect it is - then the answer is probably even more nuanced.

You are missing the point. No ones forcing you to use the ambulance. The point is a medical professional is recommending a ride share instead of calling an ambulance. You can say no my crushes hand will be ok and I’ll take an Uber to avoid a bill but that’s not a medical persons choice it is yours.

You are still free to take a taxi. If the medical practitioner says "we are getting you an ambulance" you can refuse and make your own way to the hospital. That is entirely legal.

However, the medical practitioner themselves cannot tell you to take an Uber to the hospital. Which is sensible.


In Canada, home of the often proposed single payer solution to the problems in the US, ambulance services are generally not covered and must be paid directly. You even pay id one gets called for you and you refuse assistance.

I gp is rarely going to be in a situation where they need to call an ambulance for a patient; generally it's going to be the organization (like a nursing home) or management/administrator to avoid potential liability


"medical transportation" has a specific meaning. It's perfectly legal to take an Uber to see your doctor. However, there are anti-kickback regulations in place for medical transportation providers for people who need things like emergency care.

choosing what avenue you use for transport yourself is fine. it's when you're told by an employer that you must use a ridesharing service that it becomes illegal.

>I think that your idea that this is illegal is pretty novel.

Tell that to the California Department of Heath Care Services...and the 49 other states who have similar regulations and regulatory agencies in place.

Lyft/Uber giving rides to people in no way means or suggests those rides are legal. And there is a differnce between non-emergency transportation and emergency transportation...but it is all highly regulated. Still doctors and drivers should both know these laws that affect them directly. If a doctor is dumb enough to put an employee with a workplace injury in a rideshare, the onus is on the driver to deny the ride and tell the rider they are licensed/insured to take a patient to the ER and they should call 911...that doesn’t happen because ride share drivers are not professional drivers who actually know the laws that regulate them.


Cute, but no it is definitely far from illegal: https://www.lyftbusiness.com/healthcare/?utm_source=google&u...

They should not be used for emergency transport, and that is part of the argument. Again, that is worthy of debate, but blanket statements about Lyft not being usable for "medical transport" aren't really useful.


You linked to a Lyft program for “Non emergency medical transportation”.

Pretty sure my comment you replied to acknowledges there is a difference between emergency and non-emergency transportation.

If you want to argue how a worker with a crushed hand/severed fingers going to the Emergency Room for emergency medical treatment isn’t an emergency...go nuts, and please feel free to be liberal with the case Law you cite.


Your original post said: "It is illegal for “ride shares” to provide medical transport." This is demonstrably false, but you still left it up there.

I clarified the difference before you linked lyft’s non-emergency medical transportation services

>And there is a differnce between non-emergency transportation and emergency transportation...but it is all highly regulated.

Nevertheless, I am right. Even to provide non-emergency medical transportation you must be registered (hold appropriate licenses/insurance), a random ride-share driver can not legally offer non-emergency medical services...unless they are registered with the government to provide those services.

Still none of them can provide emergency transport services to the public for money. So now you can continue debating that a patient with a crushed hand/severed fingers diagnosed by their doctor as needing emergency treatment in an ER is not an emergency requiring emergency transport under the law.


> Even to provide non-emergency medical transportation you must be registered (hold appropriate licenses/insurance), a random ride-share driver can not legally offer non-emergency medical services...unless they are registered with the government to provide those services.

Please can you link to the law that you're talking about?


> EMT lobby industry

I think you mean the "private EMS lobby". Individual EMTs are equally opposed to most of the legislation being pushed by big EMS companies (notably Prop 11, being voted on today, which is an attempt by AMR to avoid having to comply with meal break rules)


> I think you mean the "private EMS lobby". Individual EMTs are equally opposed to most of the legislation being pushed by big EMS companies (notably Prop 11, being voted on today, which is an attempt by AMR to avoid having to comply with meal break rules

Usually, when employees in an industry oppose an initiative, they actually file opposition to it; Prop. 11 was unusual in having no opposing argument filed, which usually only happens with non-controversial proposals.


There is no organized body of workers in the private EMS industry in California. Unions are extremely rare in private EMS.

The group behind Prop 11, Californians for Emergency Preparedness and Safety, is an AMR shell corp. AMR provided all of its funding, and it's CEO, Thomas Wagner, is the CEO of AMR's Western Region operation.


Yep... a "cute" proposition that was when I saw it on my ballot. I chose to give EMTs the chance to have a real lunch break. I am paying special attention to how that prop fares.

I think he was being sarcastic

Don't worry about the cleanup fee - your state has a number for that:

https://projects.propublica.org/graphics/workers-compensatio...


yes, those reports of serious injuries and poor medical care are pretty damning. So why doesn't osha or some other office that frequently does fine companies get involved?

OSHA completed their investigation and concluded that they are not under-reporting injuries (from the Q3 earnings call).

That statement in the Q3 earnings call is misleading. Per the article, Cal/OSHA found four other injury reporting violations but could not fine Tesla because those violations fell outside the statute of limitations. A state bill has been signed to extend it to six months, but it was passed too late for the Tesla investigation.

only $150?

you need to add professional cleaning cost and lost revenue while cleaning to the bill.

and not just professional cleaning... the injured person could've a serious illness (think HIV), so it will probably cost even more

i'd wager you'll need at least twice that amount


Which is why they should be using medical transportation services.

They should ideally* use medical transportation services if there's bleeding or a broken neck, and be able to use something cheaper if there's no danger of further injury or creating biohazards.

*Truly ideally there wouldn't be ambulance bills stuck on people, but I mean within the framework of what's currently in practice.


See the thing is, you're not able to determine whether a person is "no danger of further injury" being you aren't a medical professional.

A person with a severe impact might not have much external signs or pain, but could be bleeding internally. That would present a problem in the backseat of an uber on the highway.

Without stabilization, a broken bone can cut or puncture any number of blood vessels or organs (for a rib).

There's a reason we use medical transport after injuries -- you don't really know what might follow.

If the cost is the concern, using cheap transport isn't the answer. Either socialize the care or force workplaces to pay the EMT fees for workplace injuries. Sending someone in a cab is just not acceptable if a doctor deems medical transport necessary.

Now, all of this hinges on the particulars and accuracy of the description of the situation, which I can't really judge from the outside. But if otherwise independent medical professionals are being urged to reduce ambulance use in order to save face for the factory, that's a real problem. I'm inclined to believe the ousted clinicians and former employees, though.


> See the thing is, you're not able to determine whether a person is "no danger of further injury" being you aren't a medical professional.

They are medical professionals, and thus held to the standard of only being allowed to call an ambulance. That was the whole point.


Should it be illegal to drive a partner to the ER then?

It's not illegal, but it's stupid except in dire need.

If your partner goes into cardiac arrest while you're driving, what are you going to do? Stop to apply CPR and while simultaneously calling 911? Start driving faster, running red lights, and hope you both survive the trip?


Depends is your partner driving you to the ER in an emergency?

Or is your partner offering emergency services to the public in exchange for money? If so is your partner properly licensed and registered to provide those services? Is your partner insured to provide those services?


That's an entirely different point. If you're out in the middle of nowhere or even the middle of downtown SF, and you cut your foot off, you can decide to do whatever you want about it. You could call an ambulance, have your wife drive you, or just lay there and bleed because you don't want to be an inconvenience. Freedom of choice, all legal options.

If you went to a licensed medical professional with your foot cut off, they're not allowed to call you a cab. They have to call an ambulance. You can tell them, to hell with your fancy EMT's and expensive rides, I'll just have my wife take me over to the ER to get this foot sewn back on, but they have to call an ambulance if you need transport. This is a liability and safety issue. It's also a kickback issue.

TL;dr- No, it shouldn't, and nobody wants to make that illegal.


Just posting this here. Choose who to believe. The medical professional who will lose his lincence and be in legal trouble if he lying, or the "news“ org with a bone to pick with Tesla who have are been proven liars by OSHA, whose investigation proved thier story about under reporting of injuries false. "I spent nearly one hour with Reveal detailing Tesla’s decision earlier this year to bring me and my medical team on site at Fremont, providing its employees with state-of-the-art occupational and musculoskeletal health care. I detailed our vision for exemplary patient care and I gave specific examples of protocol improvements and subsequent successes in outcomes in only four short months, including accurate diagnoses and reducing needless delays for advanced testing and treatment. I patiently educated Will Evans on how Tesla allowed me to give the same care to Tesla employees that I do to my private patients including ones who are professional athletes, with the ability to get necessary testing and treatment in a timely manner without being hindered by an often cumbersome California Worker’s Compensation System that sometimes negatively effects injured workers.

I counseled Will on the difference between subjective complaints of pain, which cannot be proven and are often magnified, and objective signs found only on careful clinical examination by an experienced physician. I even mailed Will a copy of a relevant chapter from the American Medical Association Return to Work Guidelines and offered to make myself available for additional questions. Research and evidence-based medicine indicate that deconditioning injuries involving sore muscles should not be treated with inactivity as this only exacerbates the problem, but should instead be treated by proactive conditioning, ergonomic modifications and supportive care. Not all patients in pain should be off work, at home and on opioids. In fact, it is most often in these patients’ best interest to have supportive care that enhances their activity, their function, and their well-being.

As a physician, my foremost obligation is to perform a careful history and physical examination, order additional tests when clinically indicated, make an accurate diagnosis, and deliver the absolute best care possible. If patients are injured and continued work presents safety issues for the patient, myself and my fellow physicians prescribe the appropriate work restrictions. Any suggestion that myself or any of my medical team at AOC allow external factors to influence our medical care in any way is false and inaccurate.

I advised Will on why ambulances should be reserved for life or limb threatening injuries and that every ambulance that is thoughtlessly called for a non-life-threatening injury is one less ambulance that is available to actually save a life rather than be used as a convenience. Most importantly, all members of my team are empowered to call 911 for any limb or life-threatening condition.

Rather than deliver an informative and balanced piece of journalism, Reveal has instead chosen to hitch its wagon to Ms. Anna Watson, a provider with whom we severed ties after less than two weeks at our clinic and about whom I cannot provide any additional comment as she is currently the subject of an investigation by the California Medical Board. Instead of highlighting the tremendous progress being made in both patient safety and patient care at Tesla, this report uses poor sourcing to tell a story consistent with a predetermined agenda.”

26 PM_ME_UR_Definitions • 1h Maybe you don't believe this guy? Maybe you think he's a genius? It doesn't really matter, leaving out this kind of information from someone you interviewed is the definition of bias. The reporter was filtering out information not because it's inaccurate, but because it didn't fit with the narrative they wanted to tell."


Even the arguments presented here trivialize complaints and treat workers as subhuman. I understand patient privacy restricts what you can say, but not disputing any of the facts gives the story MORE weight. Actively conspiracing to avoid workers comp "for their own good" [in original: "avoid sometimes negative effects"]? It might be best, from a PR perspective, to limit the damage to what's already done.

Why isn't there an Uber for ambulances yet? Seems like cutting out the dispatcher middle man for the closest available would be valuable.

In a word? Liability.

Also, where are all these privately owned gypsy ambulances that would be signing up for this service? You'd need fleets of rando EMT's just trolling around towns hoping they're going to be the closest to an emergency. The reason independent ambulances work is because they have a central dispatch to make sure things get evened out across the board.

I am a big Tesla fan but if this is true and does not improve shortly, then screw this company.

I’ve dreamt of buying a Tesla but I could not ethically rationalize that to myself if this article is true.

It also shows the problem of measuring companies by specific metrics. It sounds like good old “juking the stats” (the wire).

It gives the impression that things actually end up worse because of how injuries are measured.


I was a big Tesla fan until-

>A Tesla recruiter called me, high pressure tried to get me to move to California, ending in- "So you don't want to do anything important with your life?"

>Elon's marketing team spam reddit and manip upvotes. This was my first wakeup call that we were being tricked

>That Tesla =/= getting to Mars in 2023.

>The Chevy Bolt was car of the year. Tesla's will be unreliable for ~10 years until they work out design related issues. (This is unavoidable for every new car company)

>The horrid conditions of employees, seems like we are taking a step back in employee conditions in favor of 'progress'.

>Manipulation of news, numbers, etc... make the company seem unethical.

I still have Elon as my wallpaper, with a motivation phrase telling me to "Get to work". But I've sobered up, he was a cult of personality.


You forgot

* They track everything about the vehicles, including GPS. You have no privacy when driving in a Tesla.

* The cars have extensive DRM.

* Automatic remote updates that can, and sometimes do, brick the car.


And when the car kills you, they pick and choose some data to make public, to try to show it was in fact your fault. No thanks.

Yep and that list could be much longer. I was a Tesla fan a year ago. Now I think Elon deserves to go bankrupt, even though I think this company understands and cares about UX more than any of their major competitors.

I'd hope that "So you don't want to do anything important with your life?" wasn't in a script, and was an individual recruiter being a manipulative asshole - and once this was found out about by management (and hopefully they investigated and could find out who said it) the recruiter was then told to not say such thing again - and fired if they did.

I can't really reply to anything else you posted, there's reasonable counter-points to all of it. You shouldn't blindly trust any one source of course, and excitement/emotion for someone or an organization doing something good can prevent use from critical thinking. At the same time, it's important to understand what it means for a company to be the most shorted stock in history - and the amount of effort, and financial gain, that will come to people purposely trying to put down Tesla et al.

Good can come from this process if everyone involved is being reasonable. Is it good that someone who asked for an ambulance to go to the hospital, instead after an assessment by an onsite doctor, were said to take a Lyft? It clearly wasn't life threatening in that doctor's eyes to require the life-stabilizing ability/necessity of an ambulance - I suppose that person sharing their story might not be talking to us then today. Likewise, is the issue that Tesla is purposefully trying to avoid "an ambulance being called" to avoid a log in OSHA records? I doubt it, however this does highlight that the processes and requirements for OSHA likely need to be updated: so that if there are on-site doctors who do an assessment, then that also gets into the log. I imagine it's more likely an incomplete/inadequate process of reporting because how many work places have on-site doctors 24/7? Not very many I'm guessing.


In my opinion they’re the most shorted stock in history because their fundamentals don’t justify their huge valuation. Elon Musk’s cult of personality has encouraged investors to over-value the company in spite of some severe problems.

I remember you recently commenting trying to argue that Elon Musk has the same values as Donald Trump when it comes to the truth, so I'm going not going to trust your judgement here.

The biggest short in history aligns well with many people not having the critical thinking ability to understand all of the facets to what Elon is doing and has already done - if you look at the whole ecosystem, which I won't write out to argue for here - though I have in the past in comments. Many people invest on short-term trends and don't have the ability to actually understand from founding principles; e.g. it's why they're building a Gigafactory for batteries, to knock the cost of battery production down by 50% - and unless competitors all start trying to do the same, they're going to have higher battery costs - and so can't compete as strongly on price as Tesla can, etc.


>I can't really reply to anything else you posted, there's reasonable counter-points to all of it.

The reason these things have happened is due to the insane pressure from upper management.

Sure they can fire the guy who tried recruiting me, but that person was likely under insane pressure to get new bodies to replace the many people who left Tesla.

There is a reason these things are happening.


The clothing industry (or pretty much any low cost country manufacturing) is much much much worse than what is described here.

Ubfortunately, people buy products produced by effectively torturing workers all the time.

That doesn't in any way justify what Tesla is doing of course. Just pointing out that this is "peanuts" compared to other products that people do not tend to boycott.

Wish there was a good solution. I try to buy fairtrade-marked goods when I can but the selection is limited as most people seem to not care.

For cars, there is no measurement or guarantee that other brands are better that is easily available to me, especially if you include Asian subcontractors / parts producers.


Here's a response horseRad posted that comes from Tesla's side - https://news.ycombinator.com/item?id=18389796 - and that is from https://electrek.co/2018/11/06/tesla-fremont-factory-clinic-...

That statement isn't exactly compelling. It just resorts to ad hominem attacks in an attempt to discredit a minor piece of the article, while deflecting/ignoring the major claims (like the worker with a crushed spine who was denied an ambulance because it would've shown up on OSHA logs).

Also, this report was done by one of the most respectable investigative news organisations in the world. Its hard to see how the PR wing of a corporation that just settled with the SEC for fraud could be considered more trustworthy.


I was referencing the response from their doctor, where they have 24/7 doctors at their factory.

I'm not sure if this answer is in anything posted, however: 1) is that claim of someone with a "crushed spine denied an ambulance" proven, and 2) is "because it would've shown up on OSHA logs" proven as Tesla's reasoning, or just conjecture and/or speculation?

Likewise, why aren't people addressing that maybe an ambulance being called as the triggering something added to OSHA logs is incomplete or badly designed - and because Tesla has doctors on staff/on-site 24/7 for workers to go to first, maybe a visit to doctors should actually be the trigger adding the event to logs? Maybe the process is broken, but requiring an ambulance be called for a sprained wrist - if they trained doctors on staff to access the situation isn't reasonable, it certainly is an emotional reaction they're triggering in people though.

"Also, this report was done by one of the most respectable investigative news organisations in the world."

I've never heard of them and likewise - is this specific journalist (and perhaps the editor) known and associated with any awards the journal received?


> I'm not sure if this answer is in anything posted, however: 1) is that claim of someone with a "crushed spine denied an ambulance" proven, and 2) is "because it would've shown up on OSHA logs" proven as Tesla's reasoning, or just conjecture and/or speculation?

1) The source is named, and to be included in the article would've likely provided medical records backing up his assertions. Not to mention the fact that Tesla (which has previously demonstrated its willingness to go the media to try and discredit former employees) has not denied his claims.

2) There are multiple sources in the article that mention being taught by lawyers how to deny care in a way that avoids legal requirements to log incidents.

> I've never heard of them and likewise

That says more about you than the source, Reveal has broken a number of extremely important stories and won many awards for doing so.

> is this specific journalist (and perhaps the editor) known and associated with any awards the journal received?

You could've just clicked on the author's bio, but yes. "His reporting with a partner and CNN exposed rampant fraud in California's drug rehab system for the poor, winning an Investigative Reporters and Editors Award."


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This response was both hypocritical and immature. I'm disappointed by reading this thread.

Okay, so what was hypocritical and immature about it? Please see bji's other responses in this thread, and perhaps mine, to get a fuller picture. If you have a strong argument point then perhaps you can make me aware of hypocrisy and immaturity - I hope you do so if it's true so I can learn, albeit and alas, most people don't put that effort in and instead make a quick response of simply sharing a loose feeling without deeper critical analysis to understand the situation and feelings in depth; this is in part a problem with the lack of tone in text.

I was pointing out their ignoring of the main point of my responses, and pointing out their put down; pointing out a lack of intellectual integrity isn't a put down, whereas saying simply because I haven't heard of a source "says more about me than the source" is nonsensical. Likewise, letting them know I'm done engaging with them is better IMHO than "ghosting" them. How is there integrity in a conversation if someone simply uses put downs and ignores the one main countering point to a proposed solution? Perhaps a gentler or kinder way to put it is they're lacking intellectual honesty - in order to try to prove a point, and backing that up/reenforcing that with a put down.


[flagged]


> Please don't impute astroturfing or shillage. That degrades discussion and is usually mistaken. If you're worried about it, email us and we'll look at the data.

https://news.ycombinator.com/newsguidelines.html


If you are stable and not in immediate danger, you should absolutely take a Lyft to the hospital instead of an ambulance. Ambulances are very expensive and should be reserved for people who actually need them. What if there's a car accident and someone is bleeding out and the ambulance is delayed because it was busy transporting some guy who wanted an ambulance ride for his stable back injury?

The US will always amaze me. If you don't have enough ambulances to cover the interventions then just buy more ambulances. And what kind of ambulances should be used should be up to medical professionals, not yourself. It is fairly common in many countries for hospitals to use regular taxis instead of usual ambulances when they know it will be fine, but it should not be your call as a patient.

I guess in the US the incentive of the hospital is just to bill you as much as possible so it makes things different. In many places the incentives of the hospital are just to keep you in good health and do not overspend their budget ...


I'm not in the U.S but when I took my emergency medical lifesaving class here in Denmark (too long ago to really be useful anymore) the guy doing the class said that there are a limited number of ambulances in Copenhagen and they will refuse to do some things if they are in use (at the time I think it was 10 ambulances) I would expect it is the same everywhere - if you are not in immediate danger don't use an ambulance because the number of ambulances and medical technicians are calculated to handle the number of emergencies expected.

then again one time I helped an old lady when she biked home drunk, fell over and got a concussion and they sent an ambulance.

However in my experience the incentive of the hospital in the U.S is to bill you as much as possible.


> the incentive of the hospital in the U.S is to bill you as much as possible.

And it's worth nothing that this is very much how non-profits operate too. Without making any claims of efficiency there is a wink wink nudge nudge in the US system that overbilling wealthy and insured patients is how we cover costs for patients who cannot afford it.


> If you don't have enough ambulances to cover the interventions then just buy more ambulances

There are enough ambulances to cover legitimate needs. Why then waste money by using ambulances to transport people who would be just fine in a Lyft? That money could be better spent on actual patient care. No matter how much money you're willing to spend on healthcare, using it efficiently is always better than wasting it.

> what kind of ambulances should be used should be up to medical professionals, not yourself

Having medical professionals decide whether an ambulance is appropriate, instead of patients, is one of the main things the article is slamming Tesla for doing.


> Having medical professionals decide whether an ambulance is appropriate, instead of patients, is one of the main things the article is slamming Tesla for doing.

Medical professionals who are under orders to ignore their medical judgement and always treat patients as lightly as possible.

Also, deciding for yourself not to take an ambulance is one thing (even if questionable). Being forbidden by your employer to call 911 is something completely different.


> Having medical professionals decide whether an ambulance is appropriate, instead of patients, is one of the main things the article is slamming Tesla for doing.

TFA says Tesla managers made a policy to not involve emergency services. They are not entitled to make either a policy or a decision in this regard.

In other countries making such a policy is flat out illegal, telling subordinates to not involve emergency services is illegal and following such directions from superiors is illegal as well.


" If you don't have enough ambulances to cover the interventions then just buy more ambulances. "

No, this is kind of a naive position.

The OP's comment is to a great extent valid.

Ambulances and their staff are extremely expensive.

Do you think in Brazil, France or Japan money just grows on trees and you can just magically buy more stuff?

Medical systems the world over are failing under understaffing and over demand - and a considerable amount of the demand is small stuff.

There are many people in socialized systems who go to the clinic/hospital with great frequency - any old thing: see the doctor. It's hugely, hugely expensive. In some cases it's merited, and I understand it's a moral dilemma because often you don't know if something is serious ...

But Emergency care in particular is bonkers expensive, even by cost not profit ... and there's no getting around it.

If people need to call an Ambulance, then get one.

But if you don't need one, get in a car and go or have someone drive you.

It doesn't matter what 'system' it's in because everything associated with 'Emerg' is very costly to the system, and it will always be a very scarce resource.

I wouldn't let anyone at my company decide for me though - if I needed one I would call.

Tesla might need a union.


> Do you think in Brazil, France or Japan money just grows on trees and you can just magically buy more stuff?

No, but even Brazil can buy more ambulances.

Also in Brazil, you have paramedics that can ride motorcycles and can be sent to the site of an injury first, to stabilize the patient, provide immediate care, and prepare for the arrival of a proper ambulance. Since they are bikes, they can better navigate traffic jams and can get to the site more quickly. If it turns out that an ambulance ride is NOT required, then it can be canceled. There are some paramedics in cars for a similar function, except cars can carry more equipment.

These are trained paramedics who have seen their fair share of injuries. I'd trust them much more than a company health clinic doctor.

There ARE alternatives. Ambulances are a limited resource everywhere, but you can work around the issue.


In Switzerland the system is actually pretty good - ambulances are private companies, it cost +-500$ to get transport to hospital.

Horrible cost on the first glance, but if you actually talk to doctors (my fiancee is one), you realize most of the system is under constant overload. If they have emergency call, it can be (and often is) something trivial, when taking a cab for 5% of the costs would be more appropriate. But you have tons of crazy people (not crazy enough to be in asylum, but enough to wreak havoc on everything and everybody around them) and hypochondriacs. Polytoxicomans that effectively can't be helped.

We're not talking about a drive by a specific vehicle, but locking of 2 highly trained professionals that can't be used for any other emergency, with vehicle full of life-saving equipment. Which can easily mean another ambulance has to come from afar if needed, which can be fatal/debilitating in number of cases.

So its not about US as much, its about making system effective, because resources (people, equipment, ambulances) are scarce and you need to prioritize, or people will die. These things can and should be improved, but until they are, doctors and everybody else need to work with what they have.


In Switzerland the system is actually pretty good - ambulances are private companies, it cost +-500$ to get transport to hospital.

This is not true for the entire country. Emergency services are usually organized on a local level.

For example: In the city of Zurich emergency services are run by the city (which also serves 17 additional communities). It's very much a publicly owned and operated enterprise.

In addition there are private services, but on a very limited manner. For example: The orthodox jewish community runs its own ambulance service.

Details, in German, can be found here : https://www.stadt-zuerich.ch/pd/de/index/schutz_u_rettung_zu...


"Horrible cost"

Actually $500 is cheap. It'd be a no brainer if it were that cheap in the US.

I think 'Ambulance no Ambulance' almost has to be kind of a moral decision, not a cost one: if you don't need it, don't use it because it's a scarce resource that will always be scarce.


Much of US ambulance staffing is done by EMTs that start with less than 200 hours of training.

https://www.nremt.org/rwd/public/data/maps

(the circle thing that should be a table)


That's half true... (or maybe 3/4 true, more accurately).

There are two "halves" to EMS in the US. One half is 911/scene response, the other half is interfacility transports. It's pretty common for interfacility transport companies to staff most of their rigs with EMTs, since those patients tend to be low acuity, and just need to be moved from one hospital to another.

Companies that do 911 response generally staff their ambulances with an EMT and a paramedic. Paramedic training is several thousand hours of classroom and clinical time.

So while it's true that overall EMS is mostly EMTs, in the area we're discussing (ambulances that respond to 911 calls) paramedics are much more common. Granted, that's only a $3-5/hr difference in most places, so it's not a massive difference in cost.


EMTs spend most of their time picking old ladies up off the floor and feeding blood thinners to people who are having heart attacks. You don't need a combat medic to do that job.

Right. My point is that when assessing the level of resources the US devotes to ambulances, there's room to argue about whether the responders are highly trained or not. Paramedics certainly are, I'm not sure about (especially newly licensed) EMTs.

no, but the other 5% of people who have been obliterated in a car crash would like for one of the EMTs in the vehicle to be a combat medic I'm sure.

Do you read Reddit and post their complaints like its reality?

The US has no problem with ambulance quantities, but why take an expensive taxi ride?

Even if it was 'free', its not really free.

I completely agree that the US medical system is corrupt, https://www.opensecrets.org/lobby/top.php?indexType=s

But you have seemingly no understanding of how insurance works or how deductibles work.


In the US the normal procedure is to call 911 as an ass covering exercise.

There’s a lot of downsides to that when a true emergency isn’t happening.


> If you don't have enough ambulances to cover the interventions then just buy more ambulances.

But then we'd have to (melodramatic pause) raise taxes!

(Audience faints en masse)


The cost isn't so much the vehicle as staffing and maintaining it — ambulances, in order to be effective, have to have both an EMT and a driver on the clock.

Generally a paramedic and an EMT (who swap who's driving depending on the acuity of the call)

I think what's being missed in this specific situation is that Tesla has doctors on staff 24/7 to look at and access/deal with any injuries. Surely if it was something they can't handle they would refer them to a hospital, and if need be have an ambulance transport them.

One would think that, in the wealthiest country in human history, the answer to the question "what if there's an accident and the ambulance is delayed because it was busy" would be "get more ambulances".

Amazing.


It's not the ambulance that's expensive — it's staffing it with both an EMT and driver, even when it's not in use.

And in the wealthiest country in human history, that staffing cost is also the highest in human history.


Sounds like it would be a great entrepreneurial opportunity to start an ambulance company that delivers lower costs by increasing the supply.

ambulance "sharing"!

That gave me a nice flashback to GTA San Andreas’s ambulance mission

even in the wealthiest country in the world, there is going to be a finite number of ambulances and EMTs. you can provision enough ambulances and crew so that it's very unlikely they will be overwhelmed with legitimate emergencies, but you can't guarantee it unless you only want to make ambulances and train EMTs.

also, why not have official mini-ambulance 'carbulances' for just such lower-risk injuries ? They could be Teslas

The UK does this with rapid responder vehicles - ordinary cars outfitted with blue lights and a limited amount of first aid kit. Some NHS regions also use motorcycles, which would be very good for getting through traffic jams to an accident.

Maybe you could hail them with an app and they would show up fast and give you a quick lift to the hospital.

It’s curious how there seem to be 2 schools of thought in this thread; always with the ambulance or ambulance only when required.

I’m not totally sure why it’s created such a huge disagreement. Obviously there are some injuries which totally don’t need an ambulance, and some which do, and then a big grey space in the middle where it’s harder to tell. Unfortunately, in some places (like here in the UK), there aren’t the resources to err on the side of caution as much as in other places (by the sounds of some commenters). Being able to have an ambulance arrive within 10 minutes for any situation sounds like a wonderful luxury if you have infinite resources to burn. I personally was impressed they dispatched an ambulance when we delivered our baby at home (on the bedroom floor!). But I also felt a bit like it was a resource that might have been wasted.


You are getting it wrong.

There is only one claim, ie. "Ambulance when required". The point of contention is who decides what required means.

Tesla has a perverse cost saving incentive to recommend the cheaper option. The person in shock is no position to make a rational decision. It is medical practitioner's responsibility to put his practice before his employer and decide what is a medically appropriate response. The emergency service has an incentive to be deployed regardless of severity.

The comments section in general, agrees that a severed finger and crushed hand are sufficiently severe injuries to warrant an ambulance.

It seems pretty.obvious to me that lay-managers and CEOs should not be the ones deciding emergency policy. That is what trained practitioners are for and the expectation is that they will hold the org to a certain regulatory safety standard.


Are sufficiently severe injuries to warrant a physician, not an ambulance.

And the cheaper option for Tesla would be not to hire a team of full-fledged doctors waiting in a room 365 days/year for taking care of any injured worker.


Self evaluation of one’s situation is not ideal though.

I remember the “funny” story of the guy who accidentaly stabbed himself in the chest with a nail gun and drove to the hospital thinking “that’s a pretty f*cked up day”

It makes for a nice tale, but those people are real, and for every drama queen going to ER for a papercut there is people in serious condition waiting for a Lyft that decides to drive a better client first or stays stuck in the trafic.


This is common sense, and standard practice. There is not need to use an ambulance for everything and is not even advisable always.

Ambulance drivers are customed to drive fast and ignore any red light; they have accidents also. To expose yourself to an increase in the probability of having a car crash because you had a minor injury, or one that is stable and can not really benefit of the specialised services provided by the ambulance, is stupid. Each case is different and must be treated individually.


In the UK we have two tiers of ambulance for this purpose. One kind only turns up with basically just a van and ambulance drivers. The other kind turns up with paramedics and full kit.

Also Paramedics on motorbikes and in cars. Paramedic on a bike gets there quickly and triages/delivers critical care, cars and ambulances are stood down or dispatched as needed.

Bike paramedics stop the time-to-help-arriving clock, which is a KPI for health service administrators.

As they can't transport people to hospital and they don't carry strong painkillers they're basically useless if you've got, say, a broken arm.


It's a particularly key KPI if you happen to be having a heart attack, which is why the bikes carry defibrillators.

> Ambulances are very expensive and should be reserved for people who actually need them.

Lol what? It's the job of the state to provide adequate resources (for example, the law in Germany requires that emergency personnel be at your location in 10min tops, on average). Telling people to use an Uber/Lyft/cab due to cost concerns or not enough ambulances being available is bad. Demand proper emergency services funding from your politicians!

Obviously: when all you got is a small cut on your finger, fine, take public transport or whatever. But for a back injury?! No way in hell I'd risk my chance in public transport or taxi.


No matter how many resources you have, using them inefficiently is bad. Dispatching a team of on-call paramedics with specialized emergency equipment to non-emergency situations is bad.

What if you think you can go by Lyft and then collapse and die? You feel bad, get a Lyft and have an heart attack? Or you had a mild hard attack and think Lyft works whereas you need medical treatment immediately? You fell from a machine and have a broken arm and go by Lyft, whereas you inner injuries and collapse in the Lyft drive to hospital?

I assume you're a doctor and able to perform a medical analysis on the accident, so you're fine to go with Lyft.

I better call the emergency service and let them decide what would be the best way to go forward depending on my symptoms/injury.


Which is why we have, at least in France (and AFAIK, in most of Europe), different kind of ambulances depending on the gravity of the case.

The hospital won't send an ambulance with ER stuff for a guy who don't need it.


> Which is why we have, at least in France (and AFAIK, in most of Europe), different kind of ambulances depending on the gravity of the case.

In France firemen do a very big chunk of that work with their ambulances.


In the abstract that is certainly true, but you are missing the bigger picture. You are acting as though people are somehow able to discern what is and isn’t an emergency and decide that all by themselves with perfect accuracy.

The point here is that it is preferable to sometimes use resources badly in order to avoid sometimes not at all using the resource when it would be necessary. The point is to not discourage people from calling 911 (or the local equivalent).

If there actually are constrained resources† then, sure, that cultural value should probably be set somewhat differently, but I cannot for the life of me imagine why that should be the case in the US. It’s not necessary to set that value differently. (If it were that would be a real shame for US healthcare and you should demand immediate change from your political representatives.)

† I am aware that at some point all resources are constrained. What I’m talking about here is that the system should be designed in such a way that there is spare capacity availible at all times when looking at the maximum number of required ambulances at the same time during, say, the past twelve months.


Who said people have to decide all by themselves with perfect accuracy? Not me. Tesla employs medical professionals to make that decision. In the absence of that, people can call their doctor or 911 for advice depending on the urgency. Even a call to 911 doesn't always have to end in an ambulance ride.

> Tesla employs medical professionals to make that decision.

Medical professionals that they "incentivize" to make a specific decision they like.

> “It was bullying and pressuring to do things people didn’t believe were correct,”


Okay, but now you're arguing a different point. It doesn't follow that because Tesla is coercing its medical professionals to make unethical decisions, that you should take on the vast inefficiency of sending an ambulance for every accident, in general.

Lol, in the US ambulances are often run by private companies and the bill is delivered to the patient.

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


I know. But I still cannot believe what I'm reading. Not as a German. When I call an ambulance and get delivered to the hospital, I don't have to worry about anything financial related aside from a bit of copay for the hospital stay, but that's it.

Cost a friend from the UK €500 to get an ambulance in Germany. She was covered by her insurance but it was still a bit of a surprise for us as we don't charge anything for an ambulance.

This situation might be because the ambulances are operated by NHS which is also UK health insurance, therefore for citizens no charges apply. Similar thing in Germany: the ambulances directly bill w/ health insurances, nothing needed except the insurance cards.

Now, the NHS may not charge German patients themselves for an ambulance ride in UK but either quietly deal directly with the German insurance to get the cost back, or eat it entirely because the administrative overhead would cost more than the fees paid by German insurance would actually bring in - while the German ambulance operator might have decided to put the administrative burden on your friend.

tl;dr: international health care insurance/refunds are weird, avoid if possible...


Much better than the alternative where everyone pays and sometimes poor people use them /s

Holy shit.

Forget Uber, you better be able to walk to Canada or something.


It is not cheap to take an ambulance in Canada. In my province, they cost $250-$400 per trip. You do not call an ambulance unless you actually need medical attention at the scene or en route to the hospital.

In the US, an ambulance trip can cost thousands. Also, if after being treated / examined, your insurance decides you didn't need the ambulance, they often won't cover it.

> Lol what? It's the job of the state to provide adequate resources

Isn't it the same with ER? People are severely discouraged from using ER for any concern that doesn't require an immediate action. ERs, like ambulances, are services whose time and resources need to be highly available for those who really need them.


> People are severely discouraged from using ER for any concern that doesn't require an immediate action

There's a conflict right now in Germany, as many people turn to the ERs instead of primary care practitioners or specialized doctors (e.g. urologists), as for ordinary people it's next to impossible to get a timely appointment.

This, again, has the reason that specialized practices reserve the "timely" slots for higher paying privately insured patients, and that the distribution of general practitioners as well as their supply is a bit... mismanaged, leading to either the practices not being open at times when people are not working (in contrast to a 24/7 ER) or horribly overcrowded.


Ambulances are also used for medical transport.

If you as a patient drive yourself to an outpatient cardiology office to get some diagnostics and feel perfectly found but severe blockage is found, the staff will call an ambulance and have you transported to the nearest ED. Even if you are asymptomatic. Fun fact: this will also happen if the ED is within walking distance. There have been cases where an MA was wheeling a seeminly OK patient from a cardiology office to the ED and the patient collapsed in the hallway. That's why it's against protocol.

Yes ambulances are insanely expensive (that's another problem). But availability issues are handled by the 911 dispatcher.


Good look getting a Lyft driver to take you if you bleed.

Both options are stupid when you consider the third option: Have a coworker with a vehicle already at the location bring them to the hospital, instead of going into shock on the factory floor as the ambulance/taxi driver makes the trip over there.

Actually the Lyft is the stupidest idea here, you combine the disadvantages of ambulances with those of personal transport, with none of the pluses


If I'm about to die from shock, I'll take the ambulance responding to an emergency over a random coworker untrained in transporting a dying person driving me to the hospital in their regular car without any lights or sirens.

Am I crazy, or are dispatchers generally able to tell what needs an ambulance and what doesn’t?

You are crazy. Dispatchers cant make complex clinical decisions, even if they were doctors.

[flagged]


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