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UPDATE: CNN, Mayo Clinic trade barbs over over "escape" story

Network accused hospital of misrepresentations. Mayo says it stands by its statements.

Posted: Aug. 17, 2018 1:26 PM
Updated: Aug. 17, 2018 2:27 PM

UPDATE:  Mayo Clinic has issued a response to CNN's new statements on the 'escaped patient story.  Mayo's statement will be below, followed immediately by CNN's lates story.

Mayo Clinic Statement - “At the heart of this matter is a vulnerable patient,” says Charles (Michel) Harper, M.D., executive dean for practice, Mayo Clinic. “Mayo Clinic firmly stands behind our statements regarding care of this patient and our interactions with CNN. Our thorough, internal review determined that the care team’s actions, in addition to being lifesaving, were true to Mayo’s primary value and we fully support the actions of our staff.”

Dr. Harper points out that it’s important to reiterate these key facts:

Mayo Clinic firmly stands behind our statements regarding care of this patient and our interactions with CNN. A prolonged public debate is not in the best interest of the patient or our staff. It’s important to reiterate these key facts:

- The patient was a vulnerable adult who could not make decisions for herself during that period of recovery after life-saving brain surgery.
- The reports of abuse and the patient’s highly unstable family and social environment caused us to reach out to the courts for guidance.
- Mayo Clinic removed the mother from the hospital due to her repeated aggressive and threatening behavior towards our staff.
Public court documents illustrate the challenges facing the family, including the August 10, 2018 court-ordered removal of five children from the mother’s home and allegations of abuse and substance abuse by the mother.
- Mayo contacted law enforcement when the patient was removed from the hospital by the family against medical advice because we believed her life and safety were at risk if she did not receive appropriate medical care.
- Mayo Clinic did not attempt to take custody of the patient or become her guardian. Instead, Mayo sought judicial guidance to help identify the best person to make decisions for the patient.
- Mayo Clinic never refused a request for a transfer. We received a request to explore a transfer “within the coming week” on February 27, 2017 and did not have the chance to clarify and consider the request for a transfer of care before the patient was removed by the family from our care against medical advice on February 28, 2017.

Mayo Clinic is deeply disturbed by CNN’s sensationalized, inaccurate and incomplete reporting.

We met with CNN on background with the agreement that the conversation would inform their reporting. We did not go on camera out of concern that this would bring undue attention to a vulnerable patient.

CNN’s incomplete reporting failed to include our informed and significant concern for the patient’s safety and the public and court records or interviews with family members not closely associated with the mother.

We fully support our compassionate and dedicated staff who were and remain deeply concerned for the patient’s well-being and safety and exemplify Mayo’s values and commitment to our patients.

CNN story - Since CNN published the "Escape from the Mayo Clinic" stories, Mayo Clinic issued several responses that are critical of CNN's reporting. Mayo's responses misrepresent several facts.

In its response:

Mayo refuses to acknowledge that the patient in this story, Alyssa Gilderhus, an adult, asked to be transferred, and that her family asked as well. Mayo claims that it had no idea Alyssa wanted to leave Mayo, even though there's written proof that she did, and Mayo had access to those writings.

Mayo completely misrepresents the nature of a meeting held between CNN staffers and Mayo staffers in March. Mayo insisted that the meeting remain off the record, yet now says that the meeting was on the record. CNN has written proof that Mayo's public statements regarding this meeting are false.

Mayo refuses to acknowledge that although Mayo doctors said Alyssa was desperately ill and needed to stay in the hospital, less than 12 hours after Alyssa left the hospital, Sanford Health, a teaching hospital in South Dakota, said that Alyssa did not need to be hospitalized and sent her home.

Mayo fails to discuss that while it said it would be dangerous for her to go home, she has flourished in the year and a half since she left Mayo. She no longer needs physical or speech therapy and will start college in a few weeks.

Alyssa says Mayo's response has further traumatized her, and that she fully supports CNN's article, which she says shed light on what she describes as her horrific treatment at Mayo.

Mayo's criticisms of CNN reveal its own inaccurate and inconsistent statements about what happened during Alyssa's hospitalization after, at age 18, she suffered a burst aneurysm on Christmas Day, 2016.

Mayo has contradicted one of its own nurses about the day Alyssa left the hospital and literally laughed off a request from a lawyer representing Alyssa who asked that she be transferred to another hospital. A top Mayo executive expressed regret at how his own staffers handled the situation.

Mayo also has made critical misrepresentations about the ground rules for a four-hour meeting five Mayo staffers had with the authors of this story, Elizabeth Cohen and John Bonifield, on March 28 at Mayo offices in Rochester, Minnesota.

After CNN released its story on Monday, Mayo said that the meeting had been on the record, and CNN should have published the details.

However, CNN has proof in writing that before the story came out, Mayo officials had demanded that the meeting be considered off the record and that the information should not be reported publicly. (Highlights in emails were added by CNN.)

CNN and Mayo met initially on the condition that the information be considered off the record -- that the information not be published or aired. A release form signed by Alyssa stipulated this condition. That signed form was approved by Mayo and was on their letterhead.

After the meeting, Alyssa expressed to CNN that Mayo could put the information from the meeting on the record and make it public. CNN then asked Mayo for its permission to put the information on the record. At first, Mayo consented to putting the information on the record.

"The decision to use what was said during the in-person conversation is ultimately up to CNN and the patient, not Mayo," Kelley Luckstein, a Mayo senior communications specialist, wrote to CNN. "If you do use information from the meeting, we'd like to have it attributed to the specific person from the meeting, so we'd be happy to review the information if you don't recall who said what during the meeting."

But the next day, Luckstein changed her mind. As CNN's emails show, Mayo staffers ultimate refused to allow information from the meeting to be made public.

"I consulted with our legal team to talk through this further," Luckstein wrote to CNN on April 25. "Based on the form, Mayo and CNN do not have the authority to publicly release any background information provided during the meeting."

After CNN pressed further to have the information from the meeting put on the record, Luckstein reiterated that Mayo wouldn't allow that to happen.

"Per the signed authorization form, Mayo is not permitted to 'disseminate, publish or otherwise publicly disclose' any confidential information,' " Luckstein wrote to CNN on April 27.

Mayo continued to refuse to further discuss Alyssa's case, even after she signed a medical information release known as a HIPAA release form provided by Mayo, which explicitly permitted Mayo to discuss Alyssa's case on the record. When pressed by CNN to have the information put on the record, Luckstein's colleague in the public relations department, Ginger Plumbo, said no again.

"As you know, we consented to the face-to-face meeting with the understanding that information would not be aired publically, and with hopes that you would reconsider your decision to share the story," Plumbo wrote to CNN on May 7.

Why does all this matter?
On Wednesday, Mayo officials themselves made parts of this meeting public by putting out a press release stating that CNN failed to investigate or include the information provided by Mayo, knowing that Mayo itself was the one who precluded CNN from reporting the information.

After we published our series, Mayo revealed part of what was discussed in our meeting to a journalist from Minnesota Public Radio to produce, as Mayo CEO John Noseworthy wrote to Mayo trustees, a story that was "expected to address Mayo's commitment in caring and protecting the patient."

Since Mayo has now made this information public, and Alyssa previously agreed to make it public, CNN will now speak about this information on the record.

There are four important points.

First, Mayo has been inaccurate and untruthful about what transpired during the March 28 meeting. Officials' own claims contradict what their staffers wrote -- clearly and unequivocally -- in emails to CNN.

Second, nothing that was stated in the March 28 meeting changes CNN's story.

Third, Mayo has continued to focus on what officials perceive as inappropriate behavior by Alyssa's mother, instead of on the allegations that Alyssa's rights as a patient had been violated. Mayo has not explained why a mother's allegedly inappropriate behavior would impact the rights of an adult patient.

Fourth, while Mayo has said that Alyssa has been their top concern, Alyssa says she was treated as an "object" by Mayo and that their attacks on CNN's story have traumatized her even more.

What Mayo didn't say about the March 28 meeting
During the meeting, Mayo staffers made factual mistakes and shocking comments.

Mayo staffers denied that Alyssa and her family requested that she be transferred -- until CNN presented proof.

In its response to CNN's reporting this week, Mayo claims the family never asked for Alyssa to be transferred to another hospital.

Mayo staffers also made that claim at the March 28 meeting.

CNN asked Mayo staffers about a letter an attorney had written on Alyssa's behalf asking for "an expedited transfer."

At first, the Mayo staffers denied that such a letter existed. CNN asked if they were sure, and they said yes. CNN asked again if they were sure, and they said yes. CNN asked again.

"I don't think there was a letter," said Sherry Hubert, vice chair, Mayo Clinic Legal. "It was just a phone call. And it was not requesting transfer."

CNN then showed the Mayo staffers the letter that Karie Rego, an attorney admitted to the California Bar, wrote to a Mayo lawyer.

"Oh yes, there was a letter," Hubert said.

CNN asked what they thought about the letter at the time they received it.

The staffers laughed.

CNN asked why they were laughing.

"The lawyer letter wasn't official," said Dr. Robert Cima, who, as chair of the Rochester Hospital Practice, serves as the hospital's medical director.

CNN asked why they didn't consider the letter from Rego "official."

The staffers laughed.

"You should call her a 'lawyer,'" Cima said, making air quotes around the word "lawyer."

CNN asked him to explain. Rego was admitted to the California Bar in 2000, where she's now an inactive member. She was a partner at McDermott Will & Emery, a leading international law firm, for eight years, according to the firm. She's spoken at national conferences, including at a meeting of the American Health Lawyers Association.

She volunteered to be a patient advocate for Alyssa while she was at Mayo.

"She's not really a lawyer," Cima said.

CNN asked him what he meant, but the staffers continued to laugh and declined to explain why they were laughing, or why they didn't take Rego's letter seriously.

Prior to Rego's letter, Alyssa and her family say they made repeated requests of doctors and nurses for Alyssa to be transferred to another hospital.

Also at the meeting, Mayo staffers said Alyssa never asked to be transferred, and neither did anyone in her family. When CNN mentioned that Alyssa and her family had asked to leave Mayo, the staffers said that this was the first time they'd heard that.

Then they said that because they were concerned about the mother's behavior, they were closely monitoring the mother's social media posts. A February 23 post on the public Facebook page of Alyssa's mother, Amber Engebretson, clearly stated that the family wanted Alyssa transferred.

A Mayo executive expressed regret about the handling of Alyssa's situation.

Ken Ackerman, administrator of Saint Marys Hospital, Mayo Clinic, said at the meeting that he wished the doctors treating Alyssa had come to him sooner as the conflicts with the family were escalating.

"I have regrets that that Bob [Cima] and I were not brought in earlier," he said. "A third party could have de-escalated the tension."

Mayo's Hubert interrupted Ackerman. "You're being too hard on yourself, Ken," she said.

A Mayo official made a major mistake about Alyssa's age.

At the outset of the meeting, Cima, the only physician present, said that Alyssa was a minor, and proceeded to give an analysis of her stay based on her being a minor.

Laws governing minors and adults in these situations are very different.

CNN corrected Cima and said Alyssa was 18 -- a legal adult -- during her entire hospital stay.

Cima said that CNN was wrong and proceeded to refer to her as a minor.

CNN again corrected Cima, and he again stated that we were wrong and he was right.

Finally, one of his colleagues corrected him and Cima brushed it off.

"She was in high school. She was a kid," Cima said, and continued to refer to Alyssa as a "kid" throughout the meeting.

Mayo contradicted police and its own nurse on a crucial issue.

At the meeting, Mayo staffers said Alyssa was abducted from the hospital, even though Alyssa says she left of her own free will, and Rochester police agreed with her, saying there was no abduction.

In the police report, a Mayo nurse who witnessed Alyssa's departure from Mayo said, "Alyssa seemed to feel safe getting into the vehicle and had no hesitations."

Mayo staffers misunderstood the use of a hospital ethics committee.

CNN interviewed four experts specializing in medical ethics or law, all of whom now, or in the past, have worked for large and well-respected academic hospitals.

These experts said that when family and staff get into conflict, it's standard operating procedure to call on the hospital ethics committee to help sort things out.

At the March 28 meeting, the Mayo staffers said the hospital's ethics committee was never consulted.

Ackerman, the hospital administrator, said ethics committees were not meant to handle such conflicts.

Mayo staffers wouldn't respond to Alyssa's accusation that a doctor dismissed her wishes to have a friend with her during an exam and then told Alyssa the teen who had raped her years earlier was trying to reach her.

During her hospital stay, Alyssa asked that a family friend, Joy Schmitt, stay with her while a doctor did a physical examination. Both Alyssa and Schmitt say the doctor told Schmitt she had to leave.

Schmitt left, leaving Alyssa alone. Then, Alyssa says, the doctor told her that the teen convicted of sexually assaulting her a few years before -- her biological father's wife's son -- had been calling the hospital looking for her. She said she cried when the doctor brought up the name of her rapist, but the doctor kept talking about him.

Alyssa said the doctor's comments traumatized her.

"It was like going back to the day it happened," she said.

At the March 28 meeting, CNN asked about this, and the staffers said they didn't know anything about it, but would get back to CNN. They never did.

CNN is publicly mentioning the rape now with Alyssa's permission.

Mayo's accusations against CNN
We'll take Mayo's criticisms of CNN one by one. The quotes below are from a letter that Chris Gade, chair of Mayo's Department of Public Affairs, wrote to Rick Davis, CNN's executive vice president of news standards and practices, on Wednesday. Mayo posted this letter on its website.

Mayo says CNN's Cohen and Bonifield "chose to disregard and not investigate key facts that were shared with them." They then listed the following items:

"The role of the biological father in making care decisions for his daughter during her hospital stay when the mother was unavailable."

At the March 28 meeting, Mayo staffers told CNN that they wanted Alyssa's biological father, Jason Gilderhus, to agree to become Alyssa's guardian and make medical decisions for her.

Ackerman said he and other staffers met with Jason on the night of February 25 and "he was a very reasonable guy."

Jason has a significant criminal record, with two assault convictions, including one for domestic assault, in addition to convictions for DWI, disorderly conduct, unspecified misdemeanors and other charges. The convictions CNN has seen are from 1995 to 2004.

At the meeting, CNN asked the Mayo staffers whether they were aware of Jason's criminal record before encouraging him to become Alyssa's guardian. They did not answer.

Mayo staffers said they were aware that when Alyssa was 16, she was sexually assaulted by her biological father's stepson. Alyssa says the rape occurred in her father's home and while her father was there. The teen was later convicted.

Alyssa told CNN that after the assault, she did not want to go to her biological father's house.

CNN made repeated unsuccessful attempts to reach Jason.

"Allegations of the mother's abuse of the patient" and "Mayo reported suspected abuse of the patient, a vulnerable adult, to the County as part of our statutory reporting requirement and reported again when the patient was removed from the hospital without a safe discharge plan."

At the March 28 meeting, Mayo staffers told CNN that during Alyssa's hospital stay, her relatives reported that her mother and stepfather, Duane Engebretson, had abused her.

CNN asked if the staffers were sure that it was relatives -- plural -- or just one relative who made this accusation. The staffers said they were sure it was more than one relative. CNN asked twice more if they were sure it was more than one relative, and twice they said they were. CNN asked the staffers to check their records, and they apologized and corrected themselves and said it was just one relative.

They said that an elderly relative made these accusations on two occasions. CNN told the staffers that, according to this man's daughter, he has dementia. The daughter said he was institutionalized at one point, and he has pushed her and has threatened to kill family members. The daughter said she'd recently run into her father at a store, and he got the store clerk, brought him to where she was shopping, and pointed at her and said she was a terrible daughter.

Plumbo, the Mayo public relations specialist at the meeting, said the staffers were unaware that the elderly relative had dementia, but they were obligated to report his accusations to county authorities.

Contrary to what Mayo has said in its responses to CNN's story, CNN did investigate these claims. CNN asked county authorities for records in this case, but the authorities declined to release any documents or make any comments, citing privacy concerns.

The Rochester Police report has details of interviews with four Mayo staffers who cared for Alyssa. None of them make any mention of abuse. CNN interviewed two Rochester Police officers who handled the case, and both said that Mayo staffers did not mention abuse to them.

"Mayo never sought to be appointed as a guardian or make decisions for the patient; instead, Mayo notified the County of the patient's vulnerable adult status and asked for assistance in identifying a decision maker."

CNN did report in our previous story what Mayo staffers told the Rochester Police Department.

The social worker told the police she'd been working with adult protection services in two Minnesota counties "trying to get emergency guardianship" but had been unable to get court orders to do so.

As we reported, an Olmsted County Adult Protective Services official told police that "Mayo was requesting [assistance] in gaining guardianship of Alyssa because they were concerned for the mother's mental health and the medical decisions that were being made for Alyssa."

CNN also reached out to the two police officers who worked on the case.

Brian Smith, the Rochester Police officer who responded to Mayo's 911 call the day Alyssa left Mayo, said a Mayo social worker told him she'd been working for a week or two to get a Minnesota county to take guardianship over Alyssa.

"The county would have guardianship over her and would make decisions for her," he told CNN.

If that happened, Alyssa most likely would have stayed at Mayo, as she was already receiving treatment there, Smith said.

Sherry Bush-Seim, a Rochester Police investigator who also worked on the case, spoke with an official at one of the county adult protection agencies. She said it was also her understanding that Mayo wanted the county to take guardianship of Alyssa, or that perhaps Mayo itself wanted to directly take guardianship of Alyssa.

"Mayo never denied a request from the family to transfer the patient to a different facility."

At the March 28 meeting, the Mayo staffers said neither Alyssa nor her family members ever asked for her to be transferred.

CNN informed them that Alyssa, her stepfather and her grandmother all said they asked repeatedly for her to be transferred.

"This is the first we're hearing about this," said Anita Milburn, social work manager, Saint Marys Hospital, Mayo Clinic.

During the meeting, Plumbo, the Mayo public relations specialist, and Ackerman, the Mayo administrator, said because they were concerned about Amber's behavior, they were vigilantly watching Amber's social media during her daughter's hospitalization.

On February 23, Amber posted on her Facebook page, which was public at the time, that they wanted to transfer Alyssa out of Mayo. "They refuse to let her go. ... We cannot transfer [Alyssa] out or get her discharged," she wrote. "No one has any say in [Alyssa's care] and she is basically a prisoner of Mayo."

After the meeting, CNN emailed Plumbo and asked her why she was unaware of the family's desire to have Alyssa transferred if they had been closely monitoring Amber's Facebook page.

Plumbo didn't answer.

As noted above, when CNN asked about the letter from the attorney, the staffers denied it and then laughed it off, saying they didn't take it seriously.

"Mayo did not arbitrarily remove the mother from the hospital; instead she was removed after she exhibited escalating disruptive and aggressive behavior that interfered with the care of her daughter and resulted in multiple staff members reporting fear for their safety. A team of Mayo staff members also met with the mother and stepfather to explain why she was removed and they expressed understanding."

In its stories earlier this week, CNN never said nor implied that Amber was "arbitrarily" removed from the hospital.

CNN published Mayo's full on-the-record statement about why they asked Amber to leave.

"Our care teams act in the best interests of our patients. As a general practice, this includes sharing information with family members and facilitating family visits and interactions with patients and their care providers when the patient is in our care. However, in situations where care may be compromised or the safety and security of our staff are potentially at risk, the family members' ability to be present in the hospital may be restricted," they wrote.

At the March 28 meeting, the Mayo staffers said Amber was removed because she was physically and verbally abusive to staffers.

None of the staffers present at the meeting had taken care of Alyssa, but they said they'd looked through her medical records and spoken to staff members who did care for her.

When CNN asked for specifics about the physical abuse, the staffers did not give specifics but just said the staff was "fearful" of Amber. When CNN asked again for specific incidents of physical abuse, Cima, the Mayo doctor, said it didn't matter, because health care providers shouldn't be abused or fear abuse in any way. When we asked again for specific incidents, they said that Amber "grabbed" a doctor's shoulder and he feared she was going to "throw a punch." We asked about the nature and circumstances of the "grabbing," they said there were no more details in the medical record.

CNN asked if we could speak to the health care providers who were involved with her care, and they said none of them would talk because they feared Amber.

When asked about the verbal abuse, the staffers said Amber kicked staff out of a room in a manner that they characterized as verbal violence.

Amber said a social worker discussed private financial information in Alyssa's hospital room within earshot of visiting friends and family, and that she asked the social worker to stop.

As CNN reported in its stories, Amber says she never touched any Mayo staffer and that at one point during a meeting she told the staff she felt like they "don't give a f***," later apologizing for her language.

CNN asked whether staffers had spoken to Amber about her behavior before they kicked her out. They said there was no record that anyone had done so.

As reported in CNN's story, Amber and Duane, Alyssa's mother and stepfather, say they never received an explanation for why she was being kicked out, either at the time or since.

"Our care team provided appropriate pain management according to the pain needs of the patient and was concerned when the mother requested opioids for her daughter so that the mother could get some sleep."

As reported in our story, when Alyssa entered the rehab unit at Mayo, she'd had four surgeries in the past month, with the last one just a few days before.

According to the Mayo Clinic's website, opioids are "critical for post-surgical pain management."

At the March 28 meeting, Mayo staffers told CNN that Alyssa didn't need pain medication because she reported having no pain.

Alyssa told CNN that during this immediate post-surgical period, she was only pain-free when she'd received a dose of painkillers. When the drugs wore off, she said she was in pain that was so severe she would cry.

At the March 28 meeting, the Mayo staffers said that Amber asked for pain medication for her daughter so that her daughter would be quiet and Amber could get some sleep.

Amber denied asking for pain medication for her daughter so that she, Amber, could sleep. She said she wanted pain medication because her daughter had just had four surgeries in the past month and she was crying from the pain.

Other accusations made by Mayo at the meeting
In the Wednesday letter to CNN's executive, Mayo said they found the following items "disturbing."

"The reporters' firm commitment to a pre-determined narrative despite contrary facts."

CNN did not have a "firm commitment to a pre-determined narrative." CNN spent more than 17 months reporting this story, exploring every angle and accusation made by the family. CNN examined documents from three law enforcement agencies; interviewed four law enforcement officers who handled the case; scoured hundreds of pages of Alyssa's medical records from two hospitals; interviewed more than six lawyers and medical ethicists; spoke to members of Alyssa's extended family and a family friend; and made four visits to Minnesota to conduct in-person interviews.

"Insisting that Mayo Clinic be prepared to defend itself instead of pursuing an accurate, fact-based story."

CNN gave Mayo ample time -- nearly a year and a half -- to tell us their version of what happened during Alyssa's hospital stay. CNN contacted Plumbo, the Mayo public relations officer, around early March, 2017. We then proceeded to have conversations with Plumbo until just days before the story published.

CNN worked with Mayo officials as they continuously changed their mind about whether they would speak with CNN.

First, Plumbo said Mayo wouldn't speak even if Alyssa signed a HIPAA release form. Months later she said Mayo would do an on-the-record interview only if Mayo health care providers could first examine Alyssa and see if she was mentally competent to sign such documents. Alyssa declined to be examined by Mayo doctors.

Then, when CNN pointed out that Alyssa's current health care providers at another hospital allowed her to sign her own medical forms, Plumbo backed off that request.

Later, Plumbo said Mayo would do an on-the-record interview with CNN if Alyssa signed a HIPAA release form.

Then when Alyssa did sign that form, Mayo declined to do the interview.

"Contacting direct patient care staff with veiled threats and asking them to breach confidentiality in order to corroborate information. This would be a potential legal breach of the patient's confidentiality for them to do so."

CNN texted and emailed several members of Alyssa's care team so that they could describe what happened during the hospital stay. No threats -- veiled or otherwise - were made.

"Contact with the patient's family prior to their removal of the patient from the hospital, demonstrating an early and unwavering faith in the patient's mother's viewpoint and prioritizing pursuit of a story over the well-being of a vulnerable adult."

While Mayo has repeatedly said that the CNN story would harm Alyssa, Alyssa disagrees. She spoke to CNN twice in person and many times over the phone in preparation for our stories.

"It didn't harm me at all. It got the word out there that this happens. It shed light," she said.

Duane also said that he fully supports the CNN story and is grateful for it.

She said the horror has come from Mayo itself disputing CNN's story.

CNN did not have an "unwavering faith" in anyone's viewpoint, which is why we spent nearly a year and a half investigating the story.

"Despite our attempts to share our concerns with the News Standards and Practices unit, and promises of fair and balanced reporting, the story that was published was factually incomplete and wholly inaccurate."

Mayo has failed to point out any facts that CNN got wrong. CNN has made no corrections or changes to the story.

Alyssa has the last word
On Thursday, Alyssa expressed sadness that Mayo was continuing to attack her and her family.

She wondered why they were focused on her mother.

She was an adult. Why would her mother's perceived bad behavior mean that Alyssa was kept in the hospital against her will? She said it just doesn't make sense.

"This is about me, not my mother," Alyssa said.

On Thursday, Mayo public relations circulated court records from late last month and earlier this month showing that Amber had tested positive for methamphetamines, and that a judge had stripped her of custody of Alyssa's five younger half-siblings, who are minors, after it was found she had abused them.

The children were taken away from their mother, and sent to live with their father, Duane, who has separated from his wife.

CNN learned about the legal proceedings against Amber and that the Engebretsons had separated after we published the articles on Monday.

The documents that Mayo circulated include the names and birth dates of her siblings.

Alyssa said she thinks Mayo continues to attack her mother because they want to deflect from the main issue: that, according to Alyssa and her family, they refused to let her leave the hospital and she had to escape.

"They're trying to create a smokescreen. I wish they would stop," she said. "This is my life. And instead of treating me like a human being, they're treating me like an object."

--
Editor's note: The original version of how CNN reported this story published on August 13.

This story is based on law enforcement documents from three police agencies in Minnesota; medical records from Alyssa Gilderhus' hospitalization at the Mayo Clinic in Rochester and her visit to an emergency room at Sanford USD Medical Center in South Dakota; a letter from and an interview with an attorney who advocated for Alyssa during her stay at Mayo; correspondence between Mayo and Alyssa's family; and interviews with Alyssa, members of her family, a family friend, law enforcement officials and a former member of a Mayo Clinic board.

CNN first spoke with Alyssa's mother, Amber Engebretson, during the final days of her daughter's stay at Mayo. She informed CNN that she and her husband would be taking Alyssa out of the hospital shortly before they did so.

While reporting this story, the authors had multiple conversations over many months with Ginger Plumbo, a spokeswoman for the Mayo Clinic. The authors also met with Plumbo and four senior Mayo officials on the condition that the information provided would be off the record.

Plumbo wrote in an email to CNN that Mayo staffers consented to the off-the-record meeting "with hopes that [CNN] would reconsider [its] decision to share the story. We feel that going on camera or audio disclosing the details about this case and the complex family situation are not in the best interest of the patient or the family."

Before that meeting, Plumbo told CNN that Mayo officials would answer CNN's questions on the record if Alyssa signed a privacy release form. Plumbo provided the form.

After the meeting, Alyssa signed the form, but then Plumbo said Mayo officials would not answer CNN's questions on the record and instead provided a statement, presented here in its entirety:

"Following careful review of the situation in question, we have determined that the version of events provided by certain patient family members to CNN are not supported by the facts nor do they track with the direct observations of numerous others who were involved. We feel we have provided CNN with more than ample information to support our findings and are deeply disappointed that the producers have chosen to pursue a false story based on a pre-determined narrative. We will not address these questionable allegations or publicly share the facts of this complex situation, because we do not believe it's in the best interest of the patient and the family.

Mayo Clinic is committed to the safety and wellbeing of all of the patients we treat.  Our internal review determined that the care team's actions were true to Mayo Clinic's primary value that the patient's needs come first.  We acted in a manner that honored that value for this patient and that also took into account the safety and well-being of the team caring for the patient."

Prior to sending the above statement, Plumbo sent CNN this statement regarding Mayo's decision to ban Alyssa's mother from the hospital:

"Our care teams act in the best interests of our patients. As a general practice, this includes sharing information with family members and facilitating family visits and interactions with patients and their care providers when the patient is in our care. However, in situations where care may be compromised or the safety and security of our staff are potentially at risk, the family members' ability to be present in the hospital may be restricted."

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