Punishing Depression

Academic medical centers (AMCs) are an influential part of the health care system in the US, and around the world. Not only do they take care of numerous, often seriously ill or disadvantaged patients, but also they are leaders in biomedical, and health care research, responsible for training medical students, young physicians, and other health professionals, and called on to provide expertise in health policy. On Health Care Renewal, we have posted unfortunately numerous examples of AMC leadership failing to live up to these missions.

A recent story in the Washington Post gives a particularly worrisome and bizarre insight into how university leadership interact with their AMCs.

In summary, Jordan Nott was an undergraduate at George Washington University. After some stressful life events, he began to experience depression. "Nott began going to the University Counseling Center, he said. He began taking psychiatric drugs and told counselors he thought about suicide but would not act on it ... and he did not attempt suicide." Depression is, of course common, and often afflicts young people. So far, this story is unremarkable.

"About 2 am one sleepless night, sophomore Jordan Nott checked himself into George Washington University Hospital." This hospital is part of George Washington University Medical Center. Part of the stated mission of the medical center is "Enhancing the delivery of compassionate and high-quality healthcare through our education and research activities." Again, so far, this story is not unusual.

As soon as Nott was admitted to the hospital, however, things went seriously awry. "Within a day and a half of arriving there, he got a letter from a GWU administrator saying his 'endangering behavior' violated the code of student conduct. He faced possible suspension and expulsion from school, the letter said, unless he withdrew and deferred the charges while he got treatment. In the meantime, he was barred from campus." "He decided not to argue his case at a school judicial hearing to be held two days after he left the hospital, he said, worried that an effort to fight the charges would fail and leave him with a permanent black mark, and expulsion or suspension, on his transcript. He withdrew, went home to upstate New York, .... Weeks later, he waited for his father and friends to lug things down from his dorm room because, he said, he had been told he could be arrested for trespassing." A Washington Post editorial stated, "'if you come onto campus for any reason, you will be trespassing and may be arrested,' the letter said."

This case has come to light because "Nott sued the university and individuals involved. The school violated federal law protecting Americans with disabilities, the complaint argues."

Thus, allegedly university administrators suspended a student, threatened him with disciplinary action, and threatened him with arrest should he appear on campus, all because he suffered from depression and was admitted to the university's AMC. It is hard to come up with words to describe these managers' behaviors. Perhaps Kafkaesque, medieval, or Stalinist might do. Clearly punishing someone because they are depressed is a gross violation of the medical center's stated mission to provide compassionate care.

Are the managers who punished Jordan Nott the sort of people we want running our great medical institututions?

The threats to free speech and academic freedom, political indoctrination, and kangaroo court justice prevalent on many US institutions of "higher learninig" are well-documented by such groups as the Foundation for Individual Rights in Education (FIRE), American Council for Trustees and Alumni (ACTA), and the National Association of Scholars (NAS). Many of my friends have argued that this sort of mismanagement of higher education may be upsetting, but it has little impact on health care. The case of Jordan Nott suggests the opposite.