Alyssa Gilderhus, 18 and a senior in high school, had been a patient at Mayo for about two months, ever since having a ruptured brain aneurysm on Christmas Day.
Mayo neurosurgeons saved her life, but she and her parents were unhappy with the care she was receiving in the rehabilitation unit, and they say they repeatedly asked for her to be transferred. But they say Mayo refused to let her transfer to another hospital, even after a lawyer wrote a letter asking Mayo to make the arrangements.
Alyssa and her family began to suspect that Mayo was trying to get a guardian appointed to make medical decisions for her. They were right: Hospital staffers would later tell police that they had gone to two county adult protection agencies to make guardianship arrangements.
Duane and his wife, Amber Engebretson, weren't sure how to get their daughter out of Mayo. Two nurses had been assigned to watch over her at all times.
But on February 28, 2017, an idea struck Duane as he sat in Alyssa's hospital room…
As he approaches the car, the front passenger door opens.
There is no Grandma Betty. She was never there. Instead, Alyssa's mother is in the driver's seat.
"Alyssa, we're going to go home, honey. Come on," Amber says to her daughter.
As Duane helps his stepdaughter out of the wheelchair and into the passenger seat, the two women in scrubs run toward her, and someone yells, "No!"
"Yes, she is! Yes, she is!" Duane and Amber yell back.
The video shows a hand grabbing Alyssa's arm as Duane helps her into the car. A nursing aide would later tell police she had tried to grab her.
"Get your hands off my daughter," Duane yells at the aide.
Duane closes the car door and gets in the back seat.
"Get out of here, Amber," he tells his wife. "Go, go, go, go, go, go!"
The car drives away from Mayo.
Recalling her escape some months later, Alyssa says it felt "phenomenal."
"It was like the biggest weight off my shoulders," she said...
An officer arrived on the scene 20 minutes later.
A Mayo social worker told him that Alyssa "cannot make decisions for herself" and that her mother couldn't care for her "because Amber has mental health issues."
The social worker also told police she "understood there was no formal diagnosis" for Amber.
Amber told CNN she has no history of mental illness and took offense to the social worker making such an unqualified pronouncement.
"It's absolutely absurd," Amber said. "She said it to the police department. She has no reasoning. She has no justification."…
But something didn't quite make sense to John Sherwin, captain of investigations for the Rochester Police Department.
If Alyssa couldn't make decisions for herself, as the social worker had said, and if she needed a legal guardian appointed for her, then who had been making decisions for her while she was in the hospital?
When police asked that question of Mayo staffers, Sherwin said, they replied that Alyssa had been making her own medical decisions.
"When doctors were consulting with her in regards to her medical care, they weren't doing so through a guardian or someone that had been appointed by the courts. It was in direct contact with the patient," Sherwin said.
He said it became clear to investigators that Alyssa "in fact could make decisions on her own" -- including the decision to leave the hospital against medical advice.
"There was no abduction. This was done under her own will," he said. "You had a patient that left the hospital under their own planning."…
Alyssa and her parents were on the run. They weren't answering their cell phones, and they weren't at home, either.
They later told CNN they figured the police would bring Alyssa to a hospital, and given the large number of Mayo facilities in Minnesota, there was a good chance that hospital would be a Mayo hospital.
"We felt that if [Mayo] got their hands on her, they would latch on and we wouldn't get her back again," Duane said…
While at the hotel, the family received a phone call from a Martin County sheriff's deputy. They say they told the deputy that their daughter was doing well, and they planned to bring her to a doctor the next day to get her checked.
The deputy said that wasn't good enough. He told them they were on their way to them, according to the family.
Alyssa and her parents scrambled and left the hotel.
It was now almost 9 p.m., and nearly five hours had passed since they'd left Mayo. The family was on the road with three police agencies -- Rochester, Mankato and Martin County -- on their heels…
After the calls from police, Alyssa's parents figured out that their phones were being pinged and took the batteries out.
They got off the highway and drove on gravel roads without a map.
"I just kept heading west. I knew I would run into South Dakota sooner or later," he said…
Less than 12 hours after leaving Mayo, she and her parents arrived at the emergency room for Sanford Medical Center in Sioux Falls, a teaching hospital for the University of South Dakota.
They explained to Sanford doctors that she'd had an aneurysm and left Mayo against medical advice, according to medical records from that emergency room visit.
The Sanford doctors disagreed with the Mayo doctors on two crucial points.
Although Mayo doctors had insisted that Alyssa needed to be in the hospital, the Sanford doctors came to the opposite conclusion: They prescribed Alyssa medications, gave instructions for her to follow up with a doctor and told her she could go home.
Mayo had determined that Alyssa lacked the mental capacity to make her own decisions. The Sanford doctors again came to the opposite conclusion: They allowed her to make her own decisions and sign her own forms consenting to treatment.
When police learned that a hospital had cleared Alyssa to go home, they stepped aside.
"If a doctor at another facility says she's fine and comes up with a second opinion, that kind of takes the law out of it," said Chris Vasvick, a Martin County sheriff's deputy. "That's one doctor's opinion against another, and that doesn't have anything to do with law enforcement at all."…
To understand the legal and ethical issues in Alyssa's case, CNN showed experts key documents, including law enforcement reports; a transcript of portions of CNN's interview with Sherwin, the detective at the Rochester Police Department; and summaries of her care written by doctors at Mayo and Sanford.
The experts emphasized that those documents don't tell the whole story; only a thorough reading of her full medical records and interviews with Mayo staff would provide a complete picture.
"You're only hearing one side," cautioned Dr. Chris Feudtner, a professor of pediatrics, medical ethics and health policy at the University of Pennsylvania Perelman School of Medicine.
After reviewing the documents, the experts wondered why Mayo did not allow Alyssa, who was 18 and legally an adult, to leave the hospital when she made clear that she wanted to be transferred, according to the family.
They said that typically, adult patients have the right to leave the hospital against medical advice, and they can leave without signing any paperwork.
"Hospitals aren't prisons. They can't hold you there against your will," said George Annas, an attorney and director of the Center for Health Law, Ethics & Human Rights at the Boston University School of Public Health.
But Alyssa's doctors say she wasn't a typical patient.
"Due to the severity of her brain injury, she does not have the capacity to make medical decisions," her doctors wrote in her records after she'd left the hospital.
In that report, the doctors specified that assessments in the last week of her hospital stay showed that she lacked "the capacity to decide to sign releases of information, make pain medication dose changes, and make disposition decisions. This includes signing paperwork agreeing to leave the hospital against medical advice."
That hadn't jibed with the captain of investigations for the Rochester police. Sherwin said it didn't make sense that Mayo staffers told police Alyssa had been making her own decisions, yet in the discharge note, they stated she wasn't capable of making her own decisions.
It didn't jibe with the experts, either.
"They can't eat their cake and have it, too," said Feudtner, the medical ethicist at the University of Pennsylvania…
Saver, the professor at the University of North Carolina School of Law, said that in his four years working in the general counsel's office at the University of Chicago Hospitals and Health System, he doesn't once remember the hospital seeking guardianship for a patient who had a responsible relative or friend who could act as surrogates.
"It's thought of as kind of the atom bomb remedy," Saver said. "I'm a little flummoxed what to make of this. They had family members on the scene to look to."…
More than a year after leaving the Mayo Clinic, Alyssa, now 20, has belied her "grim prognosis."
Last year, she graduated from Martin County West High School, receiving a standing ovation from her class. She stayed out all night at her senior prom, where her classmates voted her prom queen.
The local chapter of Future Farmers of America gave her the Star Farmer award.
Her feeding tube came out a few months after she left Mayo, and she can eat and speak normally now. She can walk on her own without any assistance. Last summer, she presented her fantail pigeons at the Minnesota State Fair and competed in the poultry princess competition.
She finished up her physical and speech therapy in March, about a year after leaving Mayo. She'll be a freshman at Southwest Minnesota State University in September.
Courtesy of a colleague
Courtesy of a colleague