California man learns he’s dying from doctor on robot video

This 2009 photo provided by Catherine Quintana shows her father, Ernest Quintana, in Fremont, California. (Catherine Quintana via AP)
Updated 09 March 2019

California man learns he’s dying from doctor on robot video

  • Hospital exec calls the situation highly unusual and said officials “regret falling short” of the patient’s expectations
  • But the hospital also defended its use of telemedicine and said its policy is to have a nurse or doctor in the room at the time of remote consultations

SAN FRANCISCO, California: Ernest Quintana’s family knew he was dying of chronic lung disease when he was taken by ambulance to a hospital, unable to breathe.
But they were devastated when a robot machine rolled into his room in the intensive care unit that night and a doctor told the 78-year-old patient by video call he would likely die within days.
“If you’re coming to tell us normal news, that’s fine, but if you’re coming to tell us there’s no lung left and we want to put you on a morphine drip until you die, it should be done by a human being and not a machine,” his daughter Catherine Quintana said Friday.
Ernest Quintana died Tuesday, two days after being taken to the Kaiser Permanente Medical Center emergency department in Fremont.
Michelle Gaskill-Hames, senior vice president of Kaiser Permanente Greater Southern Alameda County, called the situation highly unusual and said officials “regret falling short” of the patient’s expectations.
But the hospital also defended its use of telemedicine and said its policy is to have a nurse or doctor in the room at the time of remote consultations.
“The evening video tele-visit was a follow-up to earlier physician visits,” Gaskill-Hames said in a written response. “It did not replace previous conversations with patient and family members and was not used in the delivery of the initial diagnosis.”
Hospital officials say the technology doesn’t replace in-person conversations with the patient and loved ones.
Granddaughter Annalisia Wilharm, 33, was alone with Quintana when a nurse popped in to say a doctor would be making his rounds. A robot rolled in and a doctor appeared on the video screen.
Wilharm figured the visit was routine. She was astonished by what the doctor started saying.
“This guy cannot breathe, and he’s got this robot trying to talk to him,” she said. “Meanwhile, this guy is telling him, ‘So we’ve got your results back, and there’s no lung left. There’s no lung to work with.’“
Wilharm said she had to repeat what the doctor said to her grandfather, because he was hard of hearing in his right ear and the machine couldn’t get to the other side of the bed.
“So he’s saying that maybe your next step is going to hospice at home,” Wilharm is heard saying in a video she recorded of the visit. “Right?“
“You know, I don’t know if he’s going to get home,” the doctor says.
Steve Pantilat, chief of the palliative medicine division at University of California, San Francisco, said he doesn’t know the details in the case but that the robot technology has done wonders for patients and their families, some of whom are too far away for in-person visits.
The video meetings are warm and intimate, he said, adding that not all in-person discussions have empathy and compassion.
“No matter how well we deliver very difficult news, it’s sad and it’s hard to hear,” he said.
Wilharm said her grandfather, a family man who kept every childhood drawing he ever gave her, deserved better. She said that after the visit, he gave her instructions on who should get what and made her promise to look after her grandmother.
“He was such a sweet guy,” she said.


Sindhi, Baloch ‘separatists’ forming ties in Sindh, Pakistani officials say

Updated 18 sec ago

Sindhi, Baloch ‘separatists’ forming ties in Sindh, Pakistani officials say

  • Follows little-known Sindhudesh Revolutionary Army carrying out attacks

KARACHI: Investigations into a spate of recent attacks in southern Sindh province have led Pakistani officials to believe there are growing links between Sindhi separatists and militant groups from the insurgency-racked Balochistan province, officers with knowledge of the investigation have told Arab News.

However, experts warn that it may be too early to assume a “nexus” between the groups.

Late last month, gunmen attacked the Pakistan Stock Exchange building in the city of Karachi, the capital of Sindh, killing two guards and a policeman before security forces killed all four attackers.

Counterterrorism officials said that the attack had been claimed by the Baloch Liberation Army (BLA), a separatist group from the southwestern province of Balochistan, which has been designated as a terrorist organization by the US and the EU.

Just weeks earlier, three consecutive explosions killed four people, including two soldiers in Sindh. A shadowy secessionist organization, the Sindhudesh Revolutionary Army (SRA), which wants the province to break away from the Pakistani federation, claimed responsibility for the attacks. This week, SRA also claimed a grenade attack on a Karachi bakery in which a retired paramilitary Rangers official was killed. 

SRA and two other Sindhi groups were banned by the government in May this year. 

Speaking to the media after the attack on the stock exchange building,  Sindh Rangers  chief  Major General Omer Ahmed Bukhari said that the attacks proved that “hostile intelligence agencies” were working to forge a “nexus” between Sindhi and Balochi insurgent groups, adding that he believed current investigations would establish this beyond doubt. 

In a statement emailed to the media after the stock exchange attack, the BLA admitted that it had “complete support” from Sindhi groups. 

“Today both the nations (Baloch and Sindhi) are fighting for the independence of their homelands against Pakistan,” the BLA statement said. “We had the complete support of the Sindhi nation in today’s attack, and it shows a strong brotherly bond between both the nations.”

Separatists have been fighting security forces for years in Balochistan over what they see as the unfair exploitation of the province’s vast mineral wealth. Insurgents are also opposed to — and attack projects linked to — China’s Belt and Road infrastructure initiative in the resource-rich province. 

Pakistan has regularly blamed India for supporting Baloch separatists, a charge that Delhi denies.

Last month, Pakistani Prime Minister Imran Khan told parliament that he had no doubt India was behind the attack on the stock exchange building, which India promptly denied. Khan offered no evidence for his allegation, but he said that there had been intelligence reports warning of attacks in Pakistan and he had informed his Cabinet about the threats.

Sindhi separatists such as the Sindhudesh Revolutionary Army have carried out low-intensity attacks in the past, including blowing up train tracks. Their attacks, however, have been less violent than that of neighboring Balochistan where separatists have attacked a Chinese consulate, a leading hotel chain and on many occasions killed security officials patrolling a coastal highway.

Now, officials fear that Sindhi groups might be able to enhance their capacity to carry our deadlier attacks with help from Baloch militants and other hostile groups. 

“It can be a source of lawlessness in the future if this nexus is not broken,” said a police officer involved in investigating a “possible nexus between Sindhi and Baloch insurgent groups, backed by India.” He requested anonymity as he was not authorized to speak to the media about the issue.

The police official said that Baloch groups already had “some capability” to launch damaging attacks, “but once there is a nexus, it can also be helpful for Sindhi nationalists, and that’s worrisome.”

A senior intelligence officer, who also declined to be named, said there had been a noticeable increase in the frequency of attacks by Sindhi groups, which pointed to the fact that they might have more experienced helpers.

“Increase in capability (through a nexus with Baloch groups) will only be proved if they launch more sophisticated attacks,” he said. “Law enforcement agencies are absolutely aware and alert to the dangers posed by the growth of this nexus.”

Raja Umar Khattab, a senior counter-terrorism officer in Karachi, said that while teaming up with other groups might enhance the capacity of Sindhi nationalists, he did not see the nexus posing a significant threat in the near future. 

“The nexus can supplement the capacity of Sindhi sub-nationalists,” Khattab said, “but they will not be able to create any big law and order situation due to the preparedness of the law enforcement agencies.”

Sindh’s chief of Rangers has also said that Baloch and Sindh separatists were cosying up to the London faction of the Muttahida Qaumi Movement (MQM), a Pakistani political party whose leader Altaf Hussain lives in exile in London. 

“Hostile intelligence agencies strive to make a nexus of the cells, sleeper cells and facilitators of the remnant terrorist organizations (separatists), which include the remnants of the MQM,” Bukhari said during a press conference after the stock exchange attack.

The MQM, one of Pakistan’s most prominent political parties, is mostly comprised of descendants of Muslim Urdu-speaking people who migrated to Pakistan around the time of the partition of India in 1947. 

Once able to control Sindh province with an iron grip, the party’s fortunes have waned in recent years, particularly since 2013 when the military launched a crackdown against criminal groups and militants as murder rates soared and mutilated bodies were dumped in alleyways daily. Many saw the operation, centered in Karachi, as a pretext to wrest control of the port city from the MQM, an accusation that security forces deny.

While Karachi crime rates have dropped sharply and many local businesses have welcomed the operation, allegations of brutal and illegal methods have remained. 

The UN Working Group on Enforced or Involuntary Disappearances has in the past referred dozens of cases of illegal abductions of MQM workers to the Pakistan government, concluding a “pattern of specific targeting” of the MQM by Rangers, which the paramilitary force denies.

Before the 2013 operation, law enforcement agencies and many Karachi residents accused the MQM of racketeering, the abduction, torture and murder of opponents and holding the city to ransom by calling mass strikes at will.

On Wednesday, the MQM’s Qasim Ali Raza denied that the party had any links to separatists or attacks in Sindh and urged the state to stop the “blind and fraudulent” process of blaming the party. 

The Karachi-based political analyst, Mazhar Abbas, said that a nexus between the MQM and separatist groups, if it existed, would not work. 

“The workers of MQM neither accepted the alliance with Sindhi nationalists (in the past),” he said, “nor will they subscribe to the current idea of a friendship.”

Other analysts said that there was as yet no “solid” evidence to claim the nexus existed. 

“Politically, there has been some closeness between Sindhi and Baloch nationalists, but speaking about a military nexus, one needs to have solid evidence at hand,” said Sohail Sangi, a Karachi-based analyst who closely observes separatist groups.

However, Anwar Sajjadi, a Quetta-based security analyst, said that he believed a growing nexus was a possibility, adding it was no coincidence that Sindhi groups had recently started voicing opposition to Chinese projects being built under the China-Pakistan Economic Corridor (CPEC) umbrella, which Baloch groups have long opposed.

“We have seen uniformity in their stances,” Sajjadi said. “Same stance on CPEC and other (rights) issues is bringing all these groups closer.”

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