Daniel Frouman Memorial Scholarship Fund

The Daniel Frouman Memorial Scholarship Fund at Safe Passage Foundation has received an annual donation pledge that will provide scholarships of at least $500 per year for at least two students per year for five years (from 2012 until 2017).  If you can,  please donate to the scholarship fund.  If you are interested in applying for a Safe Passage Foundation Scholarship funded by the Daniel Frouman Memorial Scholarship Fund, please visit their Scholarships page at http://safepassagefoundation.org/scholarships.

Safe Passage Foundation (EIN: 30-0188676) is a not-for-profit 501(c)3 tax-exempt organization that provides resources, support and advocacy for youth raised in restrictive, isolated or high-demand communities, often referred to as “cults” by society at large.

In November 2011, Safe Passage Foundation will begin accepting scholarship applications and plans to make the first awards in January 2012.

Daniel Frouman was born in the Children of God (now known as The Family International) in April 1976 and remained there until April 1993 when he was freed by a judge who later ruled that Daniel’s basic human rights had been violated:

That in the long investigation, which has not yet concluded, by this court, to locate the FROUMAN brothers (two of the children, Emanuel David and Daniel Pasquale,  have been returned to their father), it has become aware of the existence of conduct which undoubtedly cannot be tolerated in that it clearly infringes the articles of National Law 23.849[8] (Convention On The Rights of The Child[9]), Law 23054[10](American Convention On Human Rights called Pact of San Jose of Costa Rica[11]) and Law 10.067, among other legal bodies, and which undoubtedly deserves the pertinent procedural activity of the organs of competent jurisdiction to establish not only the existence and responsibility of typical conduct but also the consequent sanction, not only against Stuart Harris Baylin but also, as will be seen, against the identified organization as they have violated the fundamental rights of people.
This is what has happened to the FROUMANS in that their identities have not been preserved, and that they were prevented from being near their parents and relatives and that they were not able to visit their mother before she died. Article 9[16] of law 23.849 was also infringed every time they were separated from their parents as has been perfectly accredited “ut supra” in the judgment of this court. Not to mention the infractions of the norms contained in articles 9[16], paragraph 3[17] and articles 11[18], 12[19], 13[20], 14[21] and 16[22] of law 23.849 among others. In this respect, these violations against the FROUMAN minors are profusely documented in the court’s records (“sub-examine”).

 

During most of his childhood (primarily from 1980 until 1993) in the isolated, restrictive and high demand organization known as “The Family,”  Daniel routinely experienced and witnessed child abuse (both physical and sexual), neglect and exploitation.  Some of the sexual abuse he experienced at a very young age (6 and 8) was violent and horrific yet not a single one of the adults in the community who were aware of its occurrence ever did anything to protect him and other children from further harm.  In most communities outside The Family, there is a good possibility that an adult who witnesses a child’s abuse “outcry” will immediately report the matter to a law enforcement or child protection agency.   In the community Daniel lived in, most of the child abuse, neglect and exploitation he experienced was promoted and encouraged in the cult’s religious publications and practiced by its top leaders and most of its adult membership.  There was little respect or regard for the basic human rights of children and reporting a credible suspicion of child abuse to a law enforcement agency was strictly forbidden and grounds for expulsion from the community.  When confronted with factual information that their minor children had been sexually and physically abused by others, many parents in The Family did nothing except label their children delusional liars and do everything possible to protect child molesters from being held accountable. Naturally, this resulted in so few criminal convictions that The Family still maintains that the number is zero (the actual number is at least two).   In one of the two known cases that resulted in a criminal conviction, a father appeared in court at a sentencing hearing to beg the judge to show leniency and give a no jail time probation only sentence to the older man who spent 9 years repeatedly sexually assaulting his daughter (starting when she was 5 years old).  The judge may have astonished but he was not persuaded and sentenced the child molester to 11 years in prison (the sentence was low because the defendant only pled guilty to one count of aggravated sexual assault and most of the crimes occurred in other jurisdictions outside the United States).  In the other case, it was a father who was sentenced to 19 years in prison for sexually assaulting his children over a period of many years.   Until it began to disintegrate, The Family was always one of the safest places in the world for child molesters.

Despite the odds against them, survivors of childhood trauma in The Family were remarkably resilient and Daniel was no exception.  After an extraordinarily traumatic and painful childhood, he began a new life at age 16 without any formal education and little help from anyone except himself.   He overcame many obstacles and worked very hard to succeed in a number of fields including music, teaching and medicine.   In 1993, he obtained a GED certificate and later began attending Austin Community College.  In 1998, he enrolled at UT-Austin and in 2002 he was awarded a Bachelor of Arts in Spanish with honors by the University of Texas at Austin and in 2006, he was awarded a Master of Arts in Spanish by Texas State University.  The offered financial aid (most small grants and large loans) was never enough so he worked many jobs (including as a bus boy, bus driver, flower delivery, office assistant, tutor, home health care aide,  musician and bartender) to pay for his education and even participated as a subject in Phase I clinical drug trials (at Pharmaco, the same place Robert Rodriguez went to get funding to produce El Mariachi) for the cash provided to compensate subjects for the inconvenience (but not the risks) of participation.  He learned how to live on inexpensive foods like Ramen noodles, rice and beans.  Even a tiny scholarship such as this one could have made a difference.

He taught a chemistry lab at Texas State for awhile and then in 2006 enrolled in his first year of medical at UT Southwestern Medical School.   In 2007, due to financial hardships, he took a break from medical school to teach undergraduate Spanish courses at Texas State University.  In April 2008, he joined the U.S. Navy as a medical student in the Navy Health Services Collegiate Program and soon attained the rank of an E-7 Chief Petty Officer.  The funding from the Navy program covered his tuition and living expenses and enabled him to return to UT Southwestern to begin his second year of medical school without the distraction of financial hardships.   He was starting his third year of medical school after taking Step 1 of the USMLE (on which he received an acceptable score) when he committed suicide on July 8, 2009.   He overcame many challenges to accomplish extraordinary things.  However, in the end he was not invulnerable to the constant pain caused by the trauma (most of which, but not all, occurred during his childhood in The Family).  In this he was not alone; over the years many children born and raised in The Family have committed suicide.  A partial and incomplete list of deaths (due to various causes including suicide, unintentional drug overdoses and medical neglect) of people born and raised in The Family can be found at the Lost Children Memorial site.

He and other children freed from The Family via a successful individual escape plan (often simply running away) or judicial intervention (such as the child abduction case involving Daniel and three of his siblings) were among the first children in The Family to begin what would later become a mass exodus of youth from the organization that eventually resulted in the failure and disintegration of most of its structural components.  The Family International is finally fading into oblivion and one can hope that eventually it will be nothing more than a bad memory.

 

Daniel’s second near-death experience

Before his death in July 2009, my brother Daniel had at least three near-death experiences.  His first near-death experience reportedly occurred shortly after his birth when he contracted pneumonia and spent weeks in a hospital in Johannesburg, South Africa.   I don’t remember much about that first time and I wasn’t  there for the third but the second  is something I’ll never forget.   As children, the story was an important part of our family folklore and loomed large in both our memories and our imaginations.

In April 1977, New York Times reporter John M. Crewdson travelled to Austin, Texas to report on a unique urban renewal project: the rapid transformation of a a dilapidated apartment complex scheduled to be demolished into a clothing optional oasis and self-described” experiment in LIBERTARIAN community”  by  Terry Parker.    A few years later,  my mother and I and my two younger brothers ended up in Austin, Texas living in a house with Terry Parker’s father and my mother’s close friend Chuck.   Later,  we moved to  the “clothing optional” New Manor apartment complex after my father and my older brother Manoli arrived from Florida.  Manoli was 7 years old, I was 5, Daniel was 4 and Jonathan was 2.

We loved playing in and around the pool.  When the sun was out, a group of old naked men could usually be found around the pool working on their tans.  Not everyone was naked and wearing clothes was certainly tolerated.  However, there was a pool dress code and those found inappropriately attired (for example, wearing jean cutoffs) were allowed to use the pool if they removed their clothing.   Manoli was the only of us who was a competent swimmer so we tried to stay out of the deep end.

One day, Daniel fell into the deep end.  I don’t recall exactly how it happened.  Sometimes Daniel said he slipped and sometimes he said he was pushed.  He was underwater for a few minutes until an alert 20-year-old naked man dove in and saved him.  After getting him out, the technique he used to help him was hold him up side down by the legs while patting his back to get the water out.  Near-death experiences were covered extensively in the religious “education” we received during our childhoods so naturally we often asked Daniel what he observed while he was unconscious.  His answer never changed: absolutely nothing.   Perhaps we were disappointed that he didn’t remember a white light at the end of the tunnel or a soft voice telling him that he was too early and was being sent back to complete an extraordinary mission.  But Daniel rarely forgot to tell us that a pair of wrinkled wet balls was the first thing he saw when he regained consciousness.

Terry Parker obituary

http://www.tributes.com/show/Terry-Parker-82239726


Crewdson, John M. “‘Liberated Apartment Complex’ Offers Nudity, Frolicking”, New York Times, April 24, 1977. A26

http://select.nytimes.com/gst/abstract.html?res=F20F17FC395812718DDDAD0A94DC405B878BF1D3

Clothing Optional At Texas Complex .
Reading Eagle – Google News Archive Dec 16, 1976

Dress Informally, Or Not At All?? .
Bonham Daily Favorite – Google News Archive- Dec 16, 1976

Dress .Informally Or Not At All .
Times-Union – Google News Archive – Dec 20, 1976

78 More Apartments Go Nude .
Lyon County Reporter – Dec 17, 1976

—terry Parker, Apartment Manager .
Lyon County Reporter – Dec 17, 1976

Apartment Complex Offers Tenants .’raw Deal .
Calgary Herald – Google News Archive – Dec 17, 1976

the Liberated Space Apts

http://groups.yahoo.com/group/LibertyProspects/message/2569

UT Southwestern: Memories of Daniel by Kirtan

Written by Kirtan Nautiyal, a classmate of Daniel’s at UT Southwestern Medical School on July 9, 2009.

I too have heard a lot of people wonder who Daniel was. And I thought I’d re-share a little of what I said at
the gathering this afternoon, because I don’t want there to be any doubt that our community really lost someone
special yesterday.

I met Daniel through our colleges group. In the medical school world, where so many of us come from similar
middle and upper class backgrounds, always having shot for that medical career, he was such a breath of fresh
air. John mentioned his “25 things” facebook note today, and I agree that it was such
a wonderful thing. Reading it, I learned about what a life he’d led, the times spent on the street earning
money playing music, the years spent touring South and North America in numerous bands, the drunken shows, a
spontaneous mountaintop marriage with a cheap ring, and about how he was “the psychiatrist” for all his
“alcoholic musician friends”, patiently listening to all their problems for hours and hours on end. He’d had
such a life, and had this huge circle of friends all across 2 continents, and I really believe that he lived
aloof from many of his classmates, because he was living on a different level than most of us, with life
experiences and dreams that were so different from most of ours. That was a valuable thing. He deleted that
note a few days later; he was a very private person.

You know, a lot of us wrote about giving and about service in our personal statements, a lot of us talk about
it, but I think very few of us really lived those sentiments in the way Daniel did, every day. I really believe
that, and I don’t say this just because he died on Wednesday. Just a few examples:

Several students and I worked most of this past year to put together a medical service trip to Haiti. We were
very passionate about this, and I told (bothered) most people about what we were doing every chance I got. I
must have mentioned the trip to Daniel once in passing, but I definitely didn’t mention that we were
fundraising or that we needed money in any way. So it was such a strange and wonderful moment when he pulled me
aside after one of our very first interminable gross tissue sessions in September, reached in his pocket, and
gave me a check for $100, telling me he didn’t need the money, to use it on the trip, I’d really need it. I was
a little bit shocked to tell you the truth, because sadly, giving freely of one’s self in this way is just
something you just don’t see much. He was a student like you and me, he had to take several jobs in medical
school to support himself, he didn’t have any money, and yet he decided that I could use this money more than
he could. If it had been most anyone else I would probably have said I couldn’t accept the gift, but in Daniel,
I really could see he wasn’t giving me the money to feel proud about himself, but because he really had no use
for money beyond making the people around him happy, and that was such a unique quality to see.

I saw that quality again when we were putting together a party for Dr. Bash, our college group mentor at the
end of the 2nd year. We were talking about getting him a gift, and it really should have been no surprise that
Daniel showed up at our next colleges group meeting and gave me an envelope saying this is my contribution –
inside was a $50 gift card to Massage Envy. Man, what a guy. I said that was a wonderful thought, and that we
would all pitch in a few bucks to distribute the cost, but Daniel said no, he had more money than he could ever
use, and that he wanted to do this, but please to tell Dr. Bash that the gift card was from all of us. It was
just me and him in the room, he wasn’t doing this to impress anyone, that was just the way he was.

It’s fitting that the last time I spoke with Daniel he was trying to get in contact with me, because I had
posted on my Facebook page the day before my USMLE that my car had broken
down. He sent me a message with his phone number, saying he’d be happy to get up at 6 and drive me twenty
minutes to the test. I replied thanks for the offer, and that I didn’t know his test was the same day as mine.
He said it wasn’t, but that he knew what it was like to be without a ride. How many of the rest of us would
have gotten up early two or three days before our own USMLE exams and spent an hour driving an acquaintance
across town like that? And the more I learn about Daniel’s life, the more I think that just about sums it up –
he wanted to give me a ride because he knew what it was like to be without a ride. He gave his money freely
because he knew what it was like to be on the street without any money. He listened to the pain and problems of
his friends, because he had felt that pain deeply himself, more deeply than perhaps we ever realized.

You know, I wasn’t Daniel’s best friend, not even close to it. He had a rich life outside of school, and I
never hung out with him beyond the times I ran into him at colleges. And I can’t help but thinking that if he
did all these wonderful things for a guy like me who he barely knew, what a kind, generous, giving friend,
brother, and son he must have been to those he was truly close to.

The UTSW and world of medicine really lost someone yesterday, they really fucking did, because I have no doubt
Daniel would have been an excellent physician, a better one that I’ll ever be.

Thanks for reading, if you did.

-Kirtan

R.I.P. Old Friend

Today brings both reflection and remembrance… As we go through life, our social skills unintentionally cause us to become somewhat selective and categorical about the people we call “friends”. You have your work buddies, family, neighbors, roommates, school pals from back in the day, people at the Kroger that you just sorta “know”, etc. etc. whatever. It’s weird when these categories intersect, we’ve all had those moments where we’re hanging out with our social friends and we recognize our co-worker at the bar. Ugh. Put out the smoke, check please and I gotta roll. To advance the idea to a more seasonable level, it’s interesting to ponder the fate of all of these relationships when you make what the insurance companies call a “life-changing event” (changing jobs, moving, having a kid, picking a different bar to hang out) and those BFF’s are no longer an instantly intimate part of your life.

To make a short point long, it’s at those “events” when you realize (and unconsciously select) who your true friends are. How many of you still hang out with your high school buddies? Is it because those relationships were so tight that they stood the test of time or that you’ve simply never left your hometown? Looking over the 35+ years of my life, it’s odd to compare the amount of people I’ve considered friends (even “good” friends) to the number I’m in relatively frequent touch with today. And I’m not talking about checking someone’s “wall” on Facebook or whatever, I mean real interaction. I guess it’s just those strange, special relationships that hold strong through time and can handle the physical distances (the typical “we pick up right where we left off” cross-country pal) tend to mature as the people involved do the same. I have friends who were my self-destructive drinking buddies back in college who are now fellow parents. And we still get along great. That’s the test of a true friendship.

On July 8, 2009, a true friend of mine passed away. Daniel Frouman.

As with most friends, I met him completely at random. Moving to Austin, TX on a whim in my early 20′s, I rented a room in some 70′s-decor rancher on the south side of the city. Owned by a nice (albeit strange, moody and probably clinically insane) alcoholic ex-hippie nicknamed “Crazy Bill,” the rent was a mere $125 month-to-month. Three roommates: two lived in other rooms in the house and the third had converted the garage into a kind of cave-like den. Since it was a garage he only payed $75 a month. This was Daniel.

I was a complete outsider in Austin. Didn’t know anyone. A suburbanite from New Jersey who had recently graduated from college and was “finding himself” (or whatever) by taking off and setting up camp across the country. The first roommate I met was Daniel. Quiet and soft-spoken, we exchanged the basic pleasantries and that was that. I left feeling like he thought I was some type of narc. Years later, once I knew the trials he had been through with his family, I would understand the reasons behind his initial trepidation about “the new guy.” Yet by the next time we stumbled into each other he was talking to me as if I were a long-lost brother, passing the beers and whatever else around. He introduced me to the other guys in the house as well as Crazy Bill. Man, what a relief! I knew I had lucked into a sweet place to crash.

I lived at the ranch for about a year and during that time became great friends with the guy. Not only was he “cool,” he was incredibly interesting; possessed an amazing shitload of stories for someone who was only 22. He had lived across South America, was chased up to the States by members of a familial cult he escaped, acted as a ball boy for Argentina’s world-renowned soccer team, and had a musical sense and could play guitar like no one I’d ever met (then or since). He was supremely mellow yet slyly sarcastic and was a lot of fun to hang out with. Although not one to really raise his voice, he was incredibly intense, as if he didn’t feel like wasting words on unimportant stuff. Daniel was definitely a guy you could learn from. We partied throughout that year without worrying about money or jobs or any real responsibilities whatsoever. Credit cards and pawn shops were our cash, Lone Star tall boys were our daily drunk. Stumbling out of bars, sleepless night of continuous partying and music, waking up in a stalled Volvo on the I-35 median, it was an absolute whirlwind of a time.

After a year or so, Crazy Bill wanted to move back into the house. He had been living in the “Love Shack” – a homemade one-room box he shared in the backyard with his giant black poodle and whatever woman he could grab at local swinger parties. It fit a king-size bed and nothing else, scavenged electricity from the house via a web of extension cords and had no running water (let’s just say Bill’s garden never lacked fresh manure). I guess the novelty of his “living off the land” project had waned and he was ready for stained shag carpeting under his feet once again. Suddenly, the rent went up and we now had our quasi-psycho landlord living with us. Within a week Daniel and I split for another apartment.

For another six months or so we stayed roommates. We rented a tiny cookie-cutter apartment that barely fit the both of us but blissfully had A/C. I never got the feeling he was completely happy there. Being at Bill’s gave him some anonymity (especially from the cult folk he worried were after him); now he was on a lease, bills were in his name, etc. There were people below and next to us who would complain if we played guitar too loud. Not enough room inside for people to hang out. No yard. It was the typical starter apartment for someone starting out in the typical working world. He wanted no part of it.

At the same time I was ready to move out as well, but for different reasons. The apartment had unintentionally given me enough of a snapshot into my next phase of my life. My two years of fucking around in Texas was coming to a close. Without knowing it I had gotten sucked into the real world, found a new job on the East Coast, and was moving out. Over time I’ve recognized that decision as the biggest crossroad in my life. It was the true beginning of my current lot and it’s strange to look back and realize it was made (rather impulsively, I may add) by a usually drunk, impetuous and supremely overconfident 24-year old. As the years have passed I’ve both been regretful and relived that I left Austin. Losing Daniel as a roommate and nearby friend is easily the biggest sorrow.

I helped Daniel move back to Bill’s, saw him a few times over those last days and left Texas abruptly. We kept in touch sporadically over the years, firstly through letters and phone; then emails and internet as the technology arrived. Still incessantly calling me “my brotha,” I was happy to learn he had started college and stuck with it, over the years I was even more impressed that he decided to go to medical school. Always affable and supportive as I spoke of the hits and misses in my life, there was never any criticism in his candor – in fact it was always the opposite. He had had a bad bike accident that challenged the future of his music playing, however his guitar playing turned out to be the exact rehabilitation his injured hand needed. Positive, positive vibes from the guy on every level. I tried to rendezvous with him a couple times during visits to Austin, unfortunately all attempts ended as nothing more then some cell phone calls and conflicting schedules. No problem, I always figured, we’d catch up at some point….

One year later all I am left with now are the memories and the music…

It is one of the real treasures Daniel brought to my life. I have always been rather picky, eccentric and private about my musical tastes, yet it was easy to open up and play the guy the most fucked-up shit in my collection. Never judging, Daniel happily gave me the skills and knowledge to not only play the stuff myself but appreciate other genres I wouldn’t have necessarily liked.

When it comes down to it, music-wise, Daniel was a genius. One of those self-taught protégés who was born with a groove, he had started playing guitar as a 3-year old peddling for coins on the streets of Argentina (how can you say “no” to a kid strumming “Bringing In The Sheaves?”) The guy didn’t just teach me guitar, he taught me about the guitar. And he didn’t stop there. He taught me how to play drums, work 4-tracks, record effects, write music… the list goes on and on. Very confident and comfortable with his skills and instruments, Daniel made a great teacher.

The band he was in during my tenure at the ranch was a funky, jazzy, hip-hop-ish outfit called Sci-Fly. They played some real groovin’ funk, very influenced by old Stevie Wonder and Parliament. After the dissolution of the group Daniel continued to record similar-sounding stuff, bypassing the need for a band and playing all the instruments himself. Throughout our later correspondence he would send tapes through the mail containing both new recordings and tweaked older stuff. He had no problem finding guest vocalists and musicians, almost everyone who knew Daniel regarded him as “the guy I’ve got to play with sometime.”

So here are those tapes, broken into 3 CDs which span the years as best as I could arrange.

Disc 1 includes Sci-Fly stuff (a live jam and demo tape) as well as some post Sci-Fly musical projects with guys from the band.

Get the Flash Player to see the wordTube Media Player.

Disc 2 opens with a hilarious recording Daniel made with his father (which at times he completely disowned) as well as a long, bare-bone recordings of what would eventually turn into Disc 3, his solo album The Funk Is Free.

Get the Flash Player to see the wordTube Media Player.

Get the Flash Player to see the wordTube Media Player.

New songs and re-recorded stuff, I lost his tracklist long ago so I gave the songs somewhat generic names. They are m4a’s ripped through iTunes, reduced to 128kbps so the .zip file would be somewhat manageable. I tried my best to upgrade the sound quality but the analog limitations of over-played (and over-dubbed) cassettes is impossible to erase. Imagine you are playing the songs through your blown-out Sanyo cassette deck and the hiss will be a lot more palatable. The tracks are soulful and jazzy, funky and deep. Whether playing his Gibson or his Rhodes, Daniel had the knack for a good groove. He could make the music funny, fearsome or funky – I’m honored to have been there when he recorded the stuff and that he thought enough of me to send the finalized tracks years later.

Check out the songs and enjoy. I’ve included the front artwork files in this post but for the backs of the album covers (and all of the other images spoken about here) check out this folder. (P.S. I know I’ve labeled their flutist Danny Anonymous but that was only because I couldn’t remember his last name – it’s actually Danny Krashen – sorry dude!)

Additionally, I thought it would be fun to scan in a couple of ancient Sci-Fly flyers that I unearthed. Might have been all of their gigs, I can’t remember. Check out versions 1, 2 and 3. Artwork by Roman.

Rest In Peace Daniel. Miss you man. Thank you for helping make living in Austin one of the best times of my life. The funk IS free my brotha.

Ethics Discussion: Rights and obligations of patients in a teaching institution

This is a presentation Daniel made at UT Southwestern in October 2008.   It was later discussed at a Children’s Medical Center Ethics Committee meeting in November 2008 and resulted in changes being made to consent forms and the general information packet provided to patients.

ETHICS DISCUSSION OUTLINE      Daniel Pasquale Frouman

I.   Case Presentation        10/22/08

II.  Ethical Questions

III.  Principles of Medical Ethics

IV. Review of Literature

I.  CASE PRESENTATION

Ms. X is a Caucasian female in her thirties who presented to Parkland for an intense burning pain in her right eye.  She denied any recent trauma.  The pain was localized and did not radiate.  She described the pain as being worse than giving birth to two infants at once.” She reported no alleviating or exasperating factors. She reported feeling “hot and clammy,” which she attributed to generalized anxiety. She denied fevers, chills, and headaches. She has had a history of three Staphylococcal infections in the past three years and reported a past history of hypertension, heart murmur, asthma, bipolar disorder, and generalized anxiety. Her family history is significant for a father and mother with diabetes.  She smokes ½ a pack of cigarettes per day and does not drink. She is a full-time single- mother of two with no college education.  Ms. X and her two children live with her parents. She was diagnosed with a Staphylococcal infection in her right eye for which she received surgical and antibiotic treatment.

When we first approached the patient we explained that we were medical students developing our history and physical exam skills and asked for her permission to be interviewed and examined.  Ms. X was not aware that she would be acting as a teaching patient and said that she did not want to be interviewed nor examined at that time. However, she later obliged, provided that we finished promptly. The fact that the patient was hesitant to be interviewed and examined by medical students prompted the following questions for discussion:

II. ETHICAL QUESTIONS

Question 1

Does the patient have the right to refuse the role of teaching patient in a teaching hospital?

Question 2

Is the indigent patient obligated to act as a teaching patient in exchange for medical care from clinical teaching institution?

Question 3

Does the patient have a moral obligation to be a teaching patient given the critical role of   the teaching hospital in the education of future physicians as well as the advancement of medical  knowledge?

III. PRINCIPLES OF MEDICAL ETHICS

  • Beneficence  The obligation of health care providers to help people in need
  • Nonmaleficence The duty of health care providers to do no harm
  • Autonomy  The right of the patients to make choices regarding their health care
  • Justice   The concept of treating everyone in a fair manner

1.  Beneficence

i. Beneficence in terms of the healthcare provider is straightforward. The individual health  care providers and the teaching hospital as a whole have made a commitment to aid patients in  need and are, thus, obliged to assist the patient.

ii.  The patient’s obligation, however, is not straightforward.  Has the patient made a  commitment to participate in the education of future physicians?

iii.   If one argues that the patient has made such a commitment by accepting services at a  teaching hospital would this be a legal obligation or a moral obligation?

iv. If the patient signed a consent form when entering the teaching hospital that clearly stated  that she would be participating as a teaching subject in a teaching hospital, is she not obliged to  participate as a teaching patient?

The following questions could be asked:

a. Did the patient completely understand the consent form she signed when entering Parkland?

b.   Does the patient completely understand the meaning of being treated at a teaching hospital?

c.   Did the patient’s illness and/or associated discomfort limit her understanding of  the consent form when admitted?

If the answer is “yes” to anyone of these three questions, then one could argue that the patient  did not give adequate informed consent and is thus not obligated to participate as a teaching   subject.

2.  Nonmaleficence

i. Medical students should refrain from performing unsupervised potentially dangerous procedures since they may harm the patient.

ii. The patient history and physical exam is noninvasive and should pose no treat to the  patient’s health.

iii. The patient may be uncomfortable or embarrassed to serve as a teaching subject.

iv. The patient’s illness and/or associated pain may deem a procedure, performed purely for    educational purposes, unnecessary.

3.  Autonomy

“Autonomy is founded in the overall desire of most human beings to control their own destiny,  to have choices in life, and to life in a society that places value on individual freedom. In medical  ethics, autonomy refers to the right of competent adult patients to consent to or refuse treatment.”

(Access Medicine—Lange Health Policy. Chapter 13. “Medical Ethics and the Rationing of  Health Care.” McGraw Hill Companies. 2008)

i. In order for the patient to be autonomous she must be given a choice and her decision    must be honored.  We allowed the patient the opportunity to choose whether she wanted    to be interviewed and examined or not.  Did we honor her decision? Did she feel     pressured to go along with the H&P?

ii. Does the indigent patient really have a choice?  If the only health care available to the    patient is via the teaching hospital, the patient has no choice but to sign the informed    consent form and participate as a teaching subject.  The indigent patient has no autonomy   in this scenario and I would argue that the only way to restore the patient’s autonomy in    this scenario is by allowing her the right to refuse acting as a teaching subject.

4.  Justice

“The principle of justice as applied to medical ethics is newer, more controversial, and harder to define than the principles of beneficence, nonmaleficence, and autonomy.  In a general sense, people are treated justly when they receive what they deserve.  It is unjust not to grant a medical degree to someone who completes medical school and passes all the necessary examinations.  It is unjust to punish a person who did not commit a crime.  In another meaning, justice refers to universal rights: to receive enough to eat, to be afforded shelter, to have access to basic medical care and education, and to be able to speak freely.  . . . justice connotes equal opportunity . . . (and) differential treatment . . . is unjust…”

(Access Medicine—Lange Health Policy. Chapter 13. “Medical Ethics and the Rationing of Health Care.” McGraw Hill Companies. 2008)

i. It would be unjust if only certain patients (e.g., indigent patients) were asked to be    teaching subjects.

ii. It would be unjust if only certain patients (e.g., wealthy, insured patients) were allowed    to refuse being teaching subjects.

iii. It would also be unjust to society as whole if clinical education were limited to only a    given subset of the population. The physician must treat patients within the entire     spectrum of humanity, irrespective of socioeconomic status, race, ethnicity and sexual    orientation.  Given the wide range of human diversity it is only logical that clinical    education encompass this diversity.

V. REVIEW OF LITERATURE

i. Patients usually sign a consent form when entering a teaching hospital. However, many patients  have not been given adequate informed consent.

a. Serious illness at the time of admission

b.  Some patients may not completely understand the meaning of being cared for in a     teaching hospital

c. Some patients may not understand the different levels of healthcare providers, i.e.,    medical students, interns, residents, fellows, and attending physicians

d. Patients may not be aware of the possible tension between the need to train new     physicians and provide quality care

ii. Patients should be informed of procedures that are being done purely for educational purposes.

iii. Noninvasive procedures (i.e., auscultation, percussion, palpation) performed by students are  allowed even if they are unnecessary.

iv. Patient participation should be requested politely and “refusal should be accepted graciously.”

v. Most patients are more than willing to participate in the educational process and the occasional  patient who refuses should not be pressured.

vi. Patients are not obligated to participate in the training of future society’s physicians. Physicians  should be “grateful for their generosity.”

vii. The teaching hospital is vital to patient care, clinical research, and clinical education.  The best  medical education is done by the bedside. Extensive studies have shown that teaching hospitals,  when compared with non-teaching hospitals, provide better care not only for patients with rare  and complex diseases but also for patients with common conditions.  Teaching hospitals provide  better care for elderly patients and are capable of providing advanced services (i.e., complicated  surgeries and bone marrow transplants) that may not be available at other hospitals.

viii. High quality patient care, state-of-the-art clinical research, innovations in clinical care, and   clinical education come with a high fiscal burden. Before Medicare and Medicaid (1966), most  funding for medical education in the U.S came from the NIH in the form of research grants not  intended for medical education.  The mergence of academic medicine with indigent and elderly  patient care began as an effort to fund medical research and education.  The idea was to treat  indigent and elderly patients in teaching hospitals, have the government fund it via Medicare and  Medicaid, and use the income for clinical research and clinical education.

ix. The public is unaware of the teaching hospital dynamic.  Educating the public may encourage  patients to participate as teaching subjects.

References

Lo B. Ethical dilemmas students and house staff face. In: Resolving Ethical Dilemmas. 3rd ed.    Baltimore: Lippincott Williams and Wilkins; 2005: 226-234

Christakis Da, Feudtner C. Ethics in a short white coat: The ethical dilemmas that medical    students confront. Acad Med 1993; 68: 249-254.

Relman, Arnold S. Who will pay for Medical Education in Our Teaching Hospitals? Science Vol. 226, No. 4670 (Oct. 1984), pp. 20-23

Ayanian, John Z. and Joel S. Weissman. (Harvard Medical School) Teaching Hospitals and    Quality of Care: A Review of the Literature. The Milbank Quarterly, Vol. 80, No. 3    (2002), pp. 569-593

Access Medicine—Clinical Ethics. Chapter 4. “Clinical Teaching.” McGraw Hill Companies.    (2008)

———- Forwarded message ———-
From: ROBERT BASH <[redacted]@childrens.com>
Date: Wed, Nov 5, 2008 at 12:56 PM
Subject: Ethics Committee
To: KAREN ECKENFELS <email redact>
Cc: Ron Somers-Clark <[redacted]@childrens.com>, Danielfrouman@gmail.com, James Wagner <[redacted]@utsouthwestern.edu>, John Sadler <[redacted]@utsouthwestern.edu>, Susan Cox <[redacted]@utsouthwestern.edu>

Karen,
I talked to Ron about a presentation that one of the second year medical students (Daniel Frouman) made to our group at UT Southwestern in the Colleges Program.  The topic was the rights/obligations of patients in a teaching institution.

I think that it would be a good topic at our next Ethics Committee Meeting.  Ron agreed.

Here is a copy of his presentation.  He gave me permission to ask you to send it to the members of the Ethics Committee at Children’s.  Could you also include a scan copy of the Children’s “Consent for Treatment/Advance Directive Notice” and the consent for surgical procedures with the email.

I would also like to invite him as my guest at the next Ethics Committee meeting when we discuss it.

Thanks
Bob

Robert Bash, M.D.
Associate Professor
Pediatric Hematology-Oncology
U.T. Southwestern Medical Center
5356 Harry Hines Blvd.
Dallas, TX  75390-9063

Director, Pediatric Palliative Care
Children’s Medical Center, Dallas
1935 Medical District Dive
Dallas, TX  75235

———- Forwarded message ———-
From: ROBERT BASH <ROBERT.BASH@childrens.com>
Date: Thu, Nov 20, 2008 at 9:49 PM
Subject: Ethics Follow-up.
To: Danielfrouman@gmail.com, Ana Castillo <[redacted]@utsouthwestern.edu>, Ben Eckert <[redacted]@utsouthwestern.edu>, Eric Gou <[redacted]@utsouthwestern.edu>, James Wagner <[redacted]@utsouthwestern.edu>, John Mcgurk <[redacted]@utsouthwestern.edu>, John Sadler <[redacted]@utsouthwestern.edu>, Kirtan Nautiyal <[redacted]@utsouthwestern.edu>, Michael Mungia <[redacted]@utsouthwestern.edu>, Susan Cox <[redacted]@utsouthwestern.edu>

Daniel,

Sorry you couldn’t make the Ethics Committee Meeting today at Children’s.  We had over 30 minutes of discussion about admission and surgical procedures consents both in general and in regard to specifically clarifying that Children’s is a teaching hospital, and medical (and nursing, and respiratory therapy, etc) are all part of the team that will be caring for the patient/child after admission.

The hospital’s lead counsel (also a member of the Ethics Committee) is going to re-work the language to specifically include students in each of the admission/consent to treat, as well as the surgical/procedures consent form.

There was also discussion about including a section in the patient’s general information packet to better explain how a teaching hospital works, and what the roles of each of the members of the team are.  They are going to discuss this at the Family Advisory Committee at an upcoming meeting.

Great Job identifying the initial problem!
Changes often start with a single voice.
Bob Bash

Good luck on the exam.

Franquismo 1939-1975

Daniel Pasquale Frouman

Franquismo 1939-1975

Economía y Demografía

Aislamiento económico–La democratización de Europa occidental, que siguió la decaída de Hítler, deja a España económicamente aislada del resto de Europa. Las Naciones Unidas implementaron un boicot a las naciones fascistas de la segunda guerra mundial. Portugal (bajo el régimen de Salazar) y la Argentina (bajo Perón) no se someten al boicot.

Autarquía como ideal político—los tecnócratas, parte de la organización católica Opus Dei, intentan crear una España autosuficiente, libre de dependencia exterior. Se funda el Instituto Nacional de Industria, en imitación a la Italia fascista, con el objetivo de crear nuevas industrias en el país.

La población española aumenta en algo más de cuatro millones de personas entre 1940 y 1960. Muchos emigran a países del río de la Plata al igual que Europa. El balance demográfico cambia. En 1940 más del 60 por ciento de la población era rural, en 1970, alrededor de 40 por ciento de la población era rural.

Nuevos desarrollos industriales, electrodomésticos y automóviles, a partir de los sesenta fomentan la urbanización de la época. El desarrollo industrial no es uniforme, por lo tanto, existe un desequilibrio entre regiones ricas y pobres.

Los franquistas consideraban el desarrollo económico e industrial de los setentas prueba del triunfo de Franco. No obstante, la inevitable creación de una generación de consumidores que acompañó el desarrollo económico de los sesentas y setentas trajo con sí cierta desarmonía y discordancia entre esta generación y las pautas tradicionales de vida en la sociedad española, dictadas por el mismo régimen franquista. Inevitablemente, se desarrollan movimientos de resistencia y protesta, encarnados en los universitarios y los obreros.

El desarrollo industrial requiere el desarrollo de la educación avanzada. Por lo tanto, se desarrollan también las universidades durante los sesentas. Sin embargo, las universidades produjeron estudiantes radicales en vez de administradores neo-capitalistas como deseaba el régimen. El pueblo quiere cambio, los estudiantes protestan y los obreros crean, ilegalmente, las Comisiones Obreras.

Estructura política bajo Franco

El sistema político, y la política franquista cambiaba levemente con el tiempo.
A esto se debe la sobrevivencia de la dictadura por tantos años en un país rodeado por países democrático. El papel, al igual que la imagen de Franco cambia con el tiempo: Franco “el conquistador” y luego Franco “el padre de la familia española”.

Se promulga la ley Orgánica con fin de crear la ilusión de la participación del pueblo en las decisiones políticas. Se instituyen a las Cortes, formados originalmente por sindicatos, los jefes de familia. Se da lugar a simulacros de comicios en que votan los sindicatos y jefes de familia.

Franco es Jefe de Estado de por vida, poseyendo el derecho de fijar y echar a cualquiera del gobierno.

Legalmente España es una monarquía tradicional católica. No totalitario, sino conservador, bajo un sistema autoritario.

Existen dos grupos católicos bajo Franco, la Asociación Nacional Católica de Propagandistas, su misión es reclutar la elite política, económica e intelectual para la Iglesia, y Opus Dei, tecnócratas mencionados anteriormente.

El gobierno estaba divida ante el tema de la sucesión de Franco. Existía un conflicto entre los Falangistas (por Franco por vida) y los monarquistas, los cuales estaban divididos en dos facciones: los Carlistas y los Alfonsistas. Franco expulsa a ambas facciones (carlistas y alfonsistas) del gobierno.

Represión de los derechos humanos

Es ilegal la asociación libre política.

Se controla estrictamente la asignación de pasaportes al igual que la distribución de carreras profesionales.

Predomina la censura en la prensa y el cine, al igual que la persecución lingüística.

Cultura Franquista y el fallo de la imposición de ésta–La censura aquietaba quizás la emergencia de una nueva cultura española, no obstante, no podía imponer la cultura franquista.

Predomina una cultura de evasión en cual el pueblo esquivaba los asuntos políticos y económicos y se emergía en el cine, la televisión y el fútbol y la literatura de kiosco. Los españoles eran fanáticos del cine con mas asiento de cine por persona que cualquier otro país europeo. Las películas de Italia y los Estados Unidos al igual que la televisión, por más que fueran censuradas, introdujeron valores sociales en disonancia con los del régimen. Aunque la mayoría de los españoles no notaban las discrepancias entre Hollywood y Madrid, el cine y la televisión contribuyeron a la evolución de una nueva cultura española.

La oposición al franquismo–El Partido Comunista, el Partido Socialista Obrero Español, y la Plataforma Democrática de España

Los intelectuales y representantes políticos de la “otra España”, socialistas y izquierdistas, estaban exiliados en Francia, Méjico y la Argentina. Por lo tanto, el partido comunista fue quién inició la lucha interna en contra del régimen franquista al apoyar a las guerrillas de los cuarentas y al entrometerse a las Comisiones Obreras.

Los comunistas, considerados herejes bajo el régimen franquista, componían la resistencia más significativa hasta los años setenta.

El régimen franquista influyó, en parte, en la creación del partido comunista con el fin de crear una ente maligna, amenazadora de España al igual que el mundo occidental.

El papel del Partido Socialista Obrero Español, controlado por exiliados de la previa generación, es mínima hasta 1972, año en cual el poder del partido pasa a las manos de jóvenes españoles y el partido expande.

Se forma, en 1975, la Plataforma Nacional de Convergencia Democrática, constituida de cristianos democráticos, monarquistas liberales, socialistas democráticos, y grupos republicanos.

My motivation for seeking a commission in the U.S. Navy Medical Corps

Frouman, Daniel. APPLICATION FOR COMMISSION IN THE U.S. NAVY/U.S. NAVY RESERVE.  2007-10-17
VIII. MOTIVATIONAL STATEMENT

Utilizing the space provided, in 400 words or less, state why you are seeking a commission.

My motivation for seeking a commission in the U.S. Navy Medical Corps is rooted in a personal resolution I made many years ago to do something useful with my life. This has also been my drive throughout college, graduate school, and medical school, as well as a teacher. I believe the Navy Medical Corps will allow me the opportunity to continue to fulfill this resolution by giving me the chance to serve my country, help those in need, and finish my medical education. Finishing college, graduate school and getting into medical school has been an upstream struggle, considering that I didnít receive much education before college and since my parents werenít around when I was growing up. However, I feel that thanks to our government I was still able to receive an education despite my lack of resources and academic preparation. I feel that by joining the Navy Medical Corps I will have an opportunity to return some of what I have been blessed with by serving as a physician for those who work so hard so for our country.
Nonetheless, I must confess that there is also part of me that wants to travel more and see more of the U.S and other parts of the world. I like adventure, seeing new places, meeting new people and learning new skills. I believe that as a Navy physician I will be able to do all of these things. I like physical activity (I run and swim almost everyday) and have always wanted to have a job someday that required some physical activity. Again, I believe that the Navy will provide this opportunity for me.

“DIARIO Daniel”

Found in Daniel’s files. Dated June 13, 2008.

Too seldom do we dwell on what lies on the exterior. We identify ourselves with what we do, what we have, what we look like.

There is a disconnection between who I believe I am and the language we use to describe and identify ourselves. What defines me is perhaps how I feel when I hear Brad Mehldau play “Alfie,” ‘Wonderwall,” “Day is Done,” or “Knives out;” Keith Jarret playing “All the things you are,” “Someday my Prince will come,” or “The Meaning of the Blues;” Coltrane playing “A love Supreme;” Buddy Guy playing “Your Damn Right I Got the Blues;” Chris Potter playing “Star Eyes;” Hendrix playing “Red House;” Luther Alison playing “Evil is going On” ….. You get the idea. Does music define me? I’m a medical student. Does medicine define me? I’m a professor. Does being a professor define me? None of these things define who I am. I love music so I play it. I want be useful so I teach and I study medicine but I feel that none of this has anything to do with who I am. To this day, I have failed to find the words that accurately define me. Maybe this is why people like Prince invent symbols to identify themselves.

I love my many friends, colleagues, students, mentors, and protégées. These folks have been my family over the years.

Recently it has been really hard to embrace everyone I encounter in San Marcos, Texas. I guess things are really fucked up in the world right now. Everyone assumes the worse. Everyone is afraid. You say “Hi” to a student outside of class after you just wrote them a letter of recommendation and they run away; you meet someone for the first time and tell them that it was nice to meet them and they don’t respond, you tell someone that you are studying medicine and they say” fuck medical science,” you decide to serve as a physician in the military and your closest friends disown you. One day these folks will ask me to write them a letter of recommendation, prescribe them drugs, save their lives, or lose my life trying to save theirs and I will gladly do my job with a smile. What will they say about medical science when they need their appendix removed, break a limb, or have cancer?

“25 things”

I found this in Daniel’s files. Apparently he posted it on Facebook (possibly in February 2009) and then removed it a few days later.

1. My name is Daniel Pasquale Frouman. Some folks call me Danielin, Danielito, Pasqualito or Che, which I don’t mind. Other folks call me Danny or Dan, which I do mind. I don’t know why.

2. I learned to play music on my own before the age of 7. I would sit on the street and watch other people play guitar and then imitate the shapes they made with their fingers on my older brother’s guitar.

3. When I was a kid I sold things on the street, I shined shoes, I sang and played guitar for change and sometimes, usually on Sundays, I would go to the market and unload sacks of potatoes from these large trucks. I guess that’s how my stepfather made a living.

4. I have slept in parks, under bridges, on the beach, and on a pool table in a bar.

5. During siesta I would take a break from work when I was a kid and go to this hotel downtown. The maids would let me play the piano in the dinning area. I don’t know what I played or even if it sounded good. I do remember that it was in E minor.

6. I know what it is like to be hungry. Real hungry.

7. Some religious folks took care of me for a while when I was a kid. I had to recite verses and even chapters from the Bible in order to eat. They also gave me a lot of work and responsibilities. I milked cows, shoveled manure, dug ditches, made bread and cheese from scratch, and spent a lot of time in the kitchen.

8. I have been to over 25 countries and I speak 4 languages fluently. For some reason I don’t have much of accent in any language so folks usually don’t think I’m a foreigner. Rather, they think I’m slow.

9. I don’t believe in God although I did when I was a kid. I have read the Bible, the Bravagad Gita, the Koran as well as all the works of Plato, Aristotle, Kant, and Nietzsche as an adolescent, followed by over 280 books encompassing the main of Latin American and Spanish Literature hoping to find truth. All I found was a piece of paper in the mail with Master of Arts written on it.

10. I remember things about everyone I meet. I’ll meet someone briefly and then run into them 2 years later and remember that they like to play tennis, that they studied psychology and that they have a dog.

11. Sometimes I feel like everything has been said already and that I have already heard everything that everyone says. It’s like I know what they are going to say before they say it.

12. I’m ambidextrous. I taught myself to write with my left hand after I was hit by a drunk driver and couldn’t use my arm for a few years after surgery.

13. I never wanted to go to medical school. I wanted to study Cell Biology and do some kind of crazy research but someone told me that someone like me could never get into medical school so I applied to prove them wrong. I was also told that I couldn’t study chemistry or biology at UT since I didn’t have a strong high school background (since I never went to high school) so I ended up doing graduate work in Chemistry just to prove them wrong. I guess I don’t like it when people tell me that I can’t do something.

14. A week after my older brother past away I ran my first marathon. He always said that he wanted to run a marathon so I ran one for him. I have been running for 15 years now.

15. I got married once. It wasn’t an official marriage. My girlfriend at the time and I went up a mountain and married each other. We bought $15 rings from Walmart, a bottle of rum, a candle and a deck of cards. We said our vows, drank rum and played rummy. So I guess that is why I have never gotten married. I need to get a divorce first. 

16. Teaching is the coolest thing I have ever done. Some of the coolest people I have met were my students.

17. I have terrible allergies in Texas, especially Austin and Dallas. I plan to move to the beach one day.

18. I want to go skydiving, learn to ski and finish an Iron Man in less than 9 hrs.

19. I bought a piano recently. Since then, everything has been great.

20. I have really good friends all over the place. Really good friends.

21. Shawshank Redemption was my all time favorite movie until The Big Lebowski.

22. I have 86 cousins.

23. I don’t like talking about myself and it feels weird to have written over 20 sentences that begin with “I”.

24. I’m obsessed with Brad Mehldau and Keith Jarrett.

25. Sometimes I feel like music is the only effective mean of communication.

Photographs

For those who are interested, I’ve uploaded a zip file (400MB) of all the images currently in the Daniel Frouman Memorial Photo Archive.

I also used Picasa to create some large collages suitable for printing and framing (note: the links should be working now, click on the thumbnails to view/download the full-size images):




On a related note, I have virtually no photographs of Daniel taken during the nearly 11-year period between October 1982 and May 1993. The main reason for this is that most of the photographs of Daniel and his siblings that were taken during this period were intentionally destroyed (“purged”) in 1992 and earlier. The few (less than 5) that I have are the rare ones that were mailed to (and saved by) some of Daniel’s relatives. I am hopeful that there are still a few more out there and that not everyone followed the orders to purge their photo collections. So anyone who has any pictures of Daniel or any of his siblings from that time period, please do the right thing and send them to me.