You Make the Call

Not everything is clear cut in life. We tend to see things through the lens of our own ideology. I get that. I am guilty, too. Let’s have a nice debate about this issue:

In Elwood, Indiana, a school superintendent has been charged with three felonies and a misdemeanor after she used her son’s name to get medical treatment for a sick student who didn’t have health insurance. Casey Smitherman says she picked up the 15-year-old student earlier this month after the teen showed symptoms of strep throat. After a medical clinic refused to see the teen because he had no insurance, Smitherman took him to a second clinic and signed him in under her son’s name. She then filled a prescription for antibiotics at a local pharmacy under her insurance. In a statement, Smitherman said, “As a parent, I know how serious this illness can be if left untreated, and I took him to an emergency clinic. I knew he did not have insurance, and I wanted to do all I could to help him get well.”


There are some clarifications needed. Other articles have show that the superintendent has been helping the kid out:

Smitherman told police that she said she had previously bought the boy clothes and helped him to clean his home, WISH-TV reports. A claim for the medical visit was valued at $233.

So, a few issues. First, $233 for a strep throat? What a joke. Second, and this is a guess, I bet he wasn’t even strep positive and the clinic was “covering” itself. See, there is my negativity right there. Third, I really appreciate how this lady has been helping the kid but she is a superintendent, not a teacher. Clean his home? Someone is spending a little too much time in that house. This story is weird.

Here is the perspective from one of my readers:

What should the ramifications be for a person acting in good conscience to prevent a serious consequence such as ARF from an untreated infection such as strep throat? We know that this intervention was crucially important for this child’s long term health. To some people, how is this different from stopping a kid from running into traffic? How can a caring educator watch their student develop ARF and other cardiac complications and know the whole time that they could have prevented it? Or for some doctors, how is this different from giving an uninsured patient free medication samples ? Don’t you suspect that the vehemence with which this case was pursued is because of the strength of the insurance companies wielding such heavy influence on the lawmakers?Why should we as a society be serving as their enforcers? Sure, she committed fraud. But why wasn’t there a readily available system that she could turn to when the kid was sick? I would show it as another failing of society  where our politics infiltrate our ability to protect the most vulnerable members (written like a true pediatrician!).

I won’t debate the frequency of acute renal failure or cardiac involvement in strep. I believe it is extremely rare. If the child was that poor than he should have Medicaid and most urgent cares even take that. Also, where the hell are the parents of this kid? How are they escaping the microscope? I do hate the insurance companies and they have made the cost of care ridiculous. This doctor brings them up but I am on not sure I they are the total villain here.

So, what do you think? You make the call? Was she right? Should she just hav used cash? Is she too enmeshed with this kid? And why are her pictures so different? I would love your thoughts.


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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  8 comments for “You Make the Call

  1. Dave Mittman
    February 1, 2019 at 3:54 pm

    It’s fraud.
    The cost of care IS way too high. Hell, I could do it for a quarter of that. BUT, that’s not the problem here. The problem as you stated is where are the parents and is there a mechanism to treat this child without resulting in fraud?
    Just my opinion.

  2. Robert Bosl
    January 31, 2019 at 11:44 am

    Did the abbreviation ARF mean acute rheumatic fever?

  3. HJR
    January 29, 2019 at 7:04 pm

    Why not just pay out of your own pocket? Why is insurance fraud necessary? Very strange.

  4. Pat
    January 29, 2019 at 12:11 pm

    There are questions and speculations, already covered above, so I’ll just take the story at face value.

    The lady’s obvious guilt is that she colored outside of the lines. A society accelerating its interconnectivity at a rate too fast for any of us to comprehend will increasingly not tolerate deviation. The rules are that every one of us is given a cubicle, with a list of other cubicles with whom we may interact, and rules governing to what degree. One must have private coverage, or one must be a government patient, or be a non-covered statistic used to drive everyone into one of the previous two camps. Blurring those lines upsets the sensibilities of everyone else in their cubicles, hoping not to get into trouble. Neither corporations nor government can tolerate a blurring of lines, except when pre-approved by lobbyists or pre-packaged “Today” hosts leading the audience through pre-scripted ethics.

    We all have our senses of right and wrong, and maybe every med student thinks doubly so. But these are coverings for basic survival. Perhaps the superintendent saw the child’s survival as key to the survival of her own sense of right/wrong, in short, herself. But humans never share the exact same value system for every situation, hence they are perpetually in conflict however benign or overt, with everyone else. Health and healing are the honestly stated goals, but their foundation is the instinct to survive, achieved only in spite of all the conflicts of corporatism, government stooges, fallible, dynamic biology, the latest social media pronouncements, and the emotions, ego, joy, desire, and fear.

    The root of all of this, even health care, is conflict, and trying to survive it for a little while, with the increasingly slim hope to escape notice. Like the old kid’s game “Operation”, she couldn’t remove the funny bone without touching the side.

  5. Bill Ameen, MD
    January 29, 2019 at 10:53 am

    Yeah, the top photo is obviously posed, with makeup. Mug shots? Remember Nick Nolte’s? I agree…Where ARE the parents? If she took him to an urgent care he was probably seen by a mid-level who likely didn’t do a rapid strep. Yes, she is too close to this kid. But she will probably be found not guilty by a sympathetic jury.

  6. PW
    January 29, 2019 at 9:42 am

    I think there is probably more to this story than is being told. Meantime, I agree her pictures don’t look that much alike, but then, my mug shots don’t look much like me either.

  7. Dr Bonz
    January 29, 2019 at 7:15 am

    I don’t know of any “clinic” that would flat out turn a child away simply because he didn’t have insurance. Go to an ER. They would HAVE to see him. But if she really wanted to help the kid, just pay for it then. Don’t commit insurance fraud.

  8. Mike Lesniak, MD, MPH
    January 29, 2019 at 6:31 am

    Yup, something here seems off I’m that relationship. Regarding the kid, what about CHIP? Medicaid? And where are the parents? Definitely off. I hate FFS, I just want to pay my bills and make people better. Why is that so complicated?

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