Culture & Ethics
When Medical Science Becomes Heartless: The Case of Joshua Smith
Updated May 19 with a response from the Carroll County, VA Sheriff’s Office.
What happens if the doctors and nurses you depend on lose their compassion? What happens if they become your accuser rather than your healer?
Those questions stuck in my mind during the last few days as I have investigated the plight of Joshua Lee Smith. Smith filed a federal lawsuit on May 3 against Twin County Regional Hospital in Galax, Virginia, as well as local police, court officials, and those who run the local jail.
Smith is currently a quadriplegic and unable to care for himself. According to his legal complaint, he “now lives permanently in long-term care facilities. He is permanently paralyzed from his chest down and will never regain the use of his legs. His paralysis has stripped him of his ability to enjoy a normal quality of life, function independently, and interact with his family as before his incapacitation.” How Joshua Smith ended up in his current tragic condition is the reason for his lawsuit.
What struck me hardest as I read the legal complaint weren’t the allegations of police brutality. Those allegations are terrible, but allegations of police misconduct have become a standard part of recent public debate.
What I found more unsettling were the allegations made against the doctors and nurses of Twin County Hospital.
An Expectation of Compassion
Today we expect doctors and nurses to be compassionate as well as professional. This expectation is largely a legacy of a Biblical worldview. The Biblical tradition upholds all humans as valuable because they are created in God’s image, and it commands us to love our neighbors as ourselves. We like to think we have progressed beyond the bad old days of leaving people to die of exposure, as happened among the ancient Greeks and Romans and many other cultures.
Once you read what allegedly happened to Joshua Smith, you might wonder whether we have progressed as much as we think.
On its website, Twin County Hospital publicly affirms the socially expected view:
At Twin County Regional Healthcare, we compassionately pursue the health and well-being of our patients, employees and the community through our culture of exceptional service and commitment to quality. Welcome to a place where people care about you and your health.
According to Joshua Smith’s attorneys, however, what Mr. Smith experienced at Twin County Hospital was anything but compassionate. The account that follows is drawn from Smith’s official legal complaint, from which I quote extensively (note: for the sake of readability, my quotations delete the numbering used in the complaint to identify specific factual allegations).
The Emergency Room from Hell
More than 15 years ago, Joshua Smith had “lower back surgery… to treat symptoms of a degenerative disease.” It didn’t go well. He was left with nerve damage and severe ongoing pain. He was legally prescribed opioids to deal with the pain, which ultimately “resulted in the development of an addiction to pain medication.”
In May 2020, Smith experienced a medical emergency. He suffered acute pain, followed by loss of sensation in his limbs, and then collapse. His family called 911, and he was taken by ambulance to the Emergency Room at Twin County Hospital. If Smith’s account is to be believed, it was the Emergency Room from Hell.
Once there, hospital staff appear to have treated him more like a criminal to be prosecuted than a patient to be treated. Allegedly dismissing his symptoms without much investigation, they ultimately refused to treat him, asserting that he must be lying about his intense pain in order to get more opioids:
Specifically, Mr. Smith was told that Twin County Hospital’s reason for refusing to treat him was because the Medical Defendants knew of his previous opioid use through the Hospital’s pain management program in 2008 and 2009… Frustrated and scared, Mr. Smith told Medical Defendants that he was not seeking pain medication, and that he was at the hospital because he was in extreme pain and was rapidly losing the functioning of his legs. His cries for help were repeatedly ignored, downplayed, and belittled by TCRH staff as his pain continued to worsen and Mr. Smith’s fear of permanent damage to his legs, back and neck increased. Instead, Medical Defendants insisted that Mr. Smith did not need medical assistance because he was, in their eyes, an addict. Medical Defendants provided only a shot of Benadryl to Mr. Smith, and — instead of treating his loss of limb function — catheterized him to perform a urine drug test. Medical Defendants knew that Mr. Smith’s reports of the loss of his lower body functioning were true — indeed, they only had to use a catheter to conduct a urine drug test because he was unable to stand or control the lower half of his body.
Things got worse according to Smith. Without his knowledge or consent, the hospital contacted the police. Exactly why the hospital called the police remains murky.
After the police were contacted, they determined that Smith had a several-years-old arrest warrant for a probation violation. So they came to arrest him. The account of what happened next is hard to read:
Defendant Nurses B, C, and D informed Mr. Smith that he was being discharged from the Hospital. Deputy V, with assistance from Nurses B, C, and D, tore Mr. Smith out of his hospital bed in an attempt to make him stand and, when he was unable to stand, they dragged him into a wheelchair and took Mr. Smith outside… Defendant Deputy V brought Mr. Smith, who was at this point weak and sedated, into his car using physical force. Unable to support his own weight, Mr. Smith fell to the ground. The four deputies violently pulled him up by his neck and under his shoulders, and Mr. Smith again fell on the concrete. The four deputies began to physically drag Mr. Smith on a rubber welcome mat, all while berating him. They called him a “piece of shit junkie,” and told Mr. Smith he’d just “shot up some bad dope.” Other than the Benadryl he had received at the hospital, Mr. Smith had not taken any drugs, and there was no reason to believe he was under the influence of drugs.
After Smith appeared before a judge, he was transported to jail. According to Smith’s attorneys, Smith was forcibly thrown into the police van for the trip:
Each throw was excruciating for Mr. Smith. As Mr. Smith’s body was repeatedly slammed into the bumper, doors, and back of the van, the pain in his legs and back burned, and — because the deputies were throwing Mr. Smith headfirst into the van — introduced new, terrifying shock waves of pain through his head and neck.
A “Rough Ride”
Smith’s attorneys allege that the police driver of the van intentionally gave Smith a what is known as a “rough ride”:
As Deputy Z drove toward the jail, he hit various potholes, cracks, and bumps in the pavement that threw Mr. Smith, who was laying unsecured on the metal floor of the van, from one side of the van to the other. Despite having Mr. Smith unsecured and moaning in pain in the back of the van, Deputy Z drove erratically, and every sharp corner or turn threw Mr. Smith across the floor… Mr. Smith alerted the Deputy to his pain, and he continued to plead for medical help because he was unable to use his legs. Mr. Smith asked Deputy Z several times to avoid hitting bumps. In response, Deputy Z accelerated the van and turned up the music in the van to drown out Mr. Smith’s pleas… At some point during the rough ride, Deputy Z accelerated over a particularly large bump on the road. As Deputy Z drove over the bump, the van jolted, Mr. Smith screamed out, and he felt a flash of pain, as if he had been shocked with a stun gun. In that moment, Mr. Smith irreparably and immediately lost all sensation in every part of his body, from his chest down. Mr. Smith tried to move his hands and legs, and realized that he was entirely immobile. He tried to move his fingers, and they were unresponsive. Shortly after being paralyzed on the floor of the police van, Mr. Smith lost consciousness.
It turned out that Joshua Smith was not lying about his medical treatment. In fact, he had a life-threatening abscess on his spine, which apparently ruptured during the “rough ride” to the jail, leaving him permanently disabled.
Later, at another hospital, Smith was told that if staff at Twin County
had conducted simple tests… such as an MRI or a CT scan, they could have identified the life-threatening abscess on his upper spine. Mr. Smith’s neck and shoulder pain and the numbness in his hands and legs were symptoms of such an abscess, and had it been identified, he could have been treated.
In other words, if Smith’s initial doctors and nurses had believed him, he might not be disabled today.
The Other Side?
As I indicated earlier, the information above comes from Smith’s legal complaint. The hospital and the police may well dispute some of these factual claims, and so I contacted both to get their side of the story.
The hospital wouldn’t get into specifics, but stated:
We just recently became aware of this lawsuit and are still in the process of investigating its claims related to the circumstances surrounding Mr. Smith’s treatment in our Emergency Department.
In compliance with the Emergency Medical Treatment & Labor Act (EMTALA), we provide a medical screening exam to every individual who presents to our emergency department for examination or treatment for an emergency medical condition. Patients are then triaged, and decisions regarding appropriate care are made based on the information our healthcare professionals have available to them at that time. We have no reason to believe that process was not followed in this situation. Additionally, federal law prohibits us from discussing any specific patient case.
Twin County is a trusted, dependable provider of quality care to Galax and the Twin Counties in Virginia, and we are committed to upholding our high standards of care and service for everyone we serve.
The Sheriff’s Office whose staff arrested and transported Smith initially did not respond to repeated requests for comment. However, after this article was originally published, Crystal Adams, Administrative Coordinator for Carroll County, VA, sent a response on behalf of the Sheriff’s Office. She wrote: “Sheriff Kemp has advised that the Sheriff’s Office has not been served with any complaint“ in the case as of yet. Ms. Adams also provided the police incident report for Joshua Smith’s arrest, which she said was the only document on file regarding the arrest. That incident report does not appear to show how or why the police learned that Mr. Smith was even at Twin County Hospital. I have asked for further clarification, and will update this article if and when I get the additional information.
Presumably as Smith’s lawsuit progresses and the defendants have to respond, we will find out what facts are in dispute, if any.
The Dehumanization of Medical Science
If the legal complaint is anywhere near accurate, the doctors and nurses at Twin County Hospital dehumanized Joshua Smith. Viewing him as an addict, they assumed he must be a liar. Yet there is nothing in the current public record to suggest they had any adequate basis for this assumption.
Did the doctors and nurses simply make a snap judgment based on little more than prejudice? Medical professionals are supposed to be experts. It can be easy for experts to act as if they are all-knowing, especially if they don’t have to justify their judgments to anyone else.
Or perhaps the doctors and nurses assumed Smith was lying based on bad experiences with other addicts. But in that case, they were equally wrong. Patients deserve individualized care, not prejudiced assessments based on the behavior of others.
Then there is the disturbing question as to why the hospital contacted the police. The hospital would have had no legitimate reason to know that Smith had an old warrant for a probation violation. Based on the complaint, they appeared to have had no real evidence he was on drugs or violating the law, only speculation. So why did they hand him over to the police? Since when have doctors and hospitals become arms of the police in America?
When I asked the hospital for further clarification about their policy of contacting the police, the response was less than illuminating: “our hospital complies with all applicable privacy regulations, and our team would disclose protected health information to law enforcement only when permitted by law.”
Perhaps the most chilling thing about this case is that it may not be an outlier. Callousness, arrogance, and a disregard for patient rights seem to be on the rise. While many doctors and nurses are highly ethical and caring people, the exceptions don’t seem so exceptional anymore.
The Ethics of “Futile Care”
Throughout America, for example, ideas about “futile care” are leading some doctors and hospitals to deny disabled babies life-saving medical treatments against the wishes of their families. My colleague Wesley J. Smith has written about one such case in a Fort Worth, Texas, hospital. The hospital tried to remove life support from a baby girl against the wishes of the girl’s mother.
But it’s not just babies who are being victimized. In 2013, teenager Justina Pelletier was forcibly confined to a psychiatric ward by Boston Children’s Hospital against her will and the will of her parents. Why? Because a hospital doctor disagreed with the diagnosis of Justina’s own doctor from Tufts University, and when Justina and her parents had the audacity to follow the advice of their original doctor, Justina’s parents were charged by the state with medical child abuse. The Pelletiers eventually sued the hospital for negligence, but lost.
Or consider the the past year’s dehumanization of those who haven’t received a COVID-19 vaccine. Whatever you think of those vaccinations, it is morally repugnant how leading public health officials, doctors, and scientists fanned the flames of prejudice and hatred against the unvaccinated. As a result, some doctors announced their refusal to serve unvaccinated people, and unvaccinated patients are being denied life-saving organ transplants.
Sadly, anyone who knows history will understand that this is not the first time doctors and nurses have been enlisted to support what amounts to social Darwinism in the guise of medicine. If you doubt this, watch my documentary Human Zoos, or read the classic article “Medical Science Under Dictatorship” by Leo Alexander, an advisor at the Nuremberg war crimes trials.
We may think that the fate of Joshua Smith could never happen to us. But we would be wrong. In some sense, what happened to Joshua Smith is happening all around us.
This might be a good time to take stock of those you rely on for your medical care. How much do you know about your doctors? Do they share your beliefs about the value of human life? Do they respect the rights of their patients? If you don’t know, you may want to find out.