The Last Free Doctor in America

He refused to sign away his constitutional rights. Then he refused to participate in modern life at all.

By Oskar Rausch

November 28, 2025

The houseboat bobs gently in Lake Huron, anchored about 200 yards off a small, nameless island in Michigan’s Thumb region. There is no dock. Visitors must hire a boat from the mainland, navigate past a half-submerged buoy, and announce themselves by shouting. A German Shepherd named Kai will bark—not aggressively, just to establish that someone is paying attention.

Dr. TooToo Medvalli, MD, will emerge from the cabin wearing a flannel shirt with a laminated pocket Constitution visible in the breast pocket. He is 61 years old, board-certified in gastroenterology, and has not practiced medicine in 18 years. He has not had a cell phone in 18 years. He has not used the internet, held a credit card, or maintained a bank account in 18 years.

He has, however, preserved every single one of his Seventh Amendment rights.

“I am aware,” he tells me, settling into a camp chair on the deck, “that this makes me sound insane.”

The numbers are not in dispute. Employees who must resolve workplace disputes through mandatory arbitration win only 21.4 percent of their cases, compared with 36.4 percent in federal court. When they do prevail, their median award of $36,500 represents barely one-fifth of the $176,426 median in court. Perhaps most troubling, researchers estimate that 98 percent of potential employment claims simply vanish—never filed because the system is designed to make pursuing them economically irrational.

These statistics come from Professor Alexander J.S. Colvin of Cornell University, whose research on employment arbitration is the most comprehensive in the field. Professor Cynthia Estlund of NYU Law School has documented what she calls “the black hole of mandatory arbitration”—the phenomenon whereby more than 60 million American workers are subject to mandatory arbitration, yet only about 2,500 employment arbitration cases are filed each year. That’s one claim for every 10,400 covered workers.

The legal scholars have a term for agreements that consumers and employees must accept without negotiation: contracts of adhesion. Sign or don’t get the job. Sign or don’t open the bank account. Sign or don’t use the cell phone.

TooToo Medvalli chose “don’t.”

To understand how a gastroenterologist ended up living on a houseboat in Lake Huron, communicating exclusively through the United States Postal Service, you have to understand that TooToo Medvalli has never done anything halfway.

He was born in 1986 in Hamtramck, Michigan, to Hungarian immigrant parents who emphasized education with the intensity common to families who had sacrificed everything to provide it. He graduated from the University of Michigan, attended the University of Michigan Medical School, completed his internal medicine residency at UCSF, and finished a gastroenterology fellowship at Stanford. By 2018, at age 32, he was a board-certified gastroenterologist with offers from three major health systems.

He was also, by his own description, “constitutionally incapable of not reading things.”

“My colleagues would get these contracts—60, 70 pages—and they’d flip to the salary section, maybe glance at the benefits, and sign,” Medvalli says. “I read every word. Every clause. Every definition in the appendix.”

It was in one of these appendices that he first encountered a mandatory arbitration clause.

“I remember the exact moment,” he says. “Page 47. ‘Any dispute arising out of or relating to this Agreement shall be resolved exclusively through binding arbitration.’ I didn’t even know what that meant. So I looked it up.”

What he found changed the trajectory of his life.

The Federal Arbitration Act of 1925 was drafted by Julius Henry Cohen, a Progressive-era lawyer, and championed by the New York Chamber of Commerce for a specific, limited purpose: enabling merchants of relatively equal bargaining power to resolve disputes efficiently outside congested courts. The drafters repeatedly assured legislators that the Act would not apply to employment contracts or adhesion contracts. Section 1 explicitly exempts “contracts of employment of seamen, railroad employees, or any other class of workers engaged in foreign or interstate commerce.”

The Supreme Court has spent the past four decades systematically transforming this narrow procedural statute into something its drafters would not recognize.

Southland Corp. v. Keating (1984) held that the FAA applies in state courts and preempts conflicting state laws—despite legislative history clearly indicating Congress viewed the FAA as purely procedural. Circuit City Stores v. Adams (2001) narrowed the employment exemption to cover only transportation workers, extending FAA coverage to virtually all employment contracts. AT&T Mobility v. Concepcion (2011) held that the FAA preempts state unconscionability doctrines that would invalidate class action waivers. Epic Systems Corp. v. Lewis (2018) ruled that employers can use individual arbitration agreements to prevent collective action even for wage and hour claims.

Justice Ruth Bader Ginsburg read her dissent in Epic Systems from the bench—a rare act of judicial protest. She called for congressional correction of the Court’s “elevation of the FAA over workers’ rights.”

Congress has not corrected it.

“I went to HR,” Medvalli recalls, “and I said, ‘I can’t sign this.’ They looked at me like I’d grown a second head.”

He explained his concerns: the elimination of jury trial rights, the restriction of discovery, the repeat-player advantage that research showed systematically favored employers, the class action waiver that would prevent workers from banding together to challenge systematic violations.

The HR representative listened politely. Then she said, “It’s standard. Everyone signs it.”

“That’s not a legal argument,” Medvalli replied. “That’s a description of capitulation.”

He was not hired.

Over the next six months, Medvalli applied to 47 different healthcare organizations. Every single one required mandatory arbitration as a condition of employment. Every single one told him it was “standard.”

“I started keeping a tally on my pocket Constitution,” he says, pulling out the document—laminated now, worn at the edges. Small hash marks cover the inside back cover. “Forty-seven rejections. All for the same reason. I wasn’t refusing to work. I wasn’t asking for more money. I was just asking to retain access to the legal system that the Constitution guarantees.”

The question everyone asks—the question I asked, standing on his houseboat deck while Kai investigated my backpack with alarming intensity—is: Why not just sign?

Medvalli has heard this question hundreds of times. He has a speech prepared.

“In 1992, the year after the Supreme Court’s Gilmer decision permitted arbitration of federal employment discrimination claims, approximately 2 percent of American workers were subject to mandatory arbitration,” he says, rattling off statistics with the fluency of a man who has spent 18 years alone with legal journals. “By 2017, that figure had reached 56.2 percent—more than 60 million workers. The Economic Policy Institute projected it would reach 80 percent by 2024. Eighty percent of American workers, required to surrender their constitutional rights as a condition of employment.”

He pauses.

“At what point does a right that can be forced-waived as a condition of basic economic participation stop being a right at all?”

The dog deserves his own explanation. Medvalli acquired Kai in 2026, shortly after losing his house to foreclosure. (The mortgage company’s arbitration clause had prevented him from disputing the foreclosure in court—a fact Medvalli describes as “darkly ironic.”) Kai is now 17 years old, ancient for a German Shepherd. In his younger years, he expressed his considerable psychological complexity through the systematic destruction of fabric, furniture, and infrastructure.

“He once humped a buoy so aggressively it sank,” Medvalli says, with something approaching affection. “I had to pay to have it replaced. In cash, obviously. I don’t have a bank account.”

The cascade of withdrawals happened gradually, then all at once.

First the employment contracts. Then the cell phone, after Medvalli actually read his Verizon service agreement and discovered that he’d theoretically agreed to waive his right to sue, his right to participate in class actions, and his right to a jury trial.

“I threw it in Lake Huron,” he says. “Kai looked very confused. He expected to retrieve it.”

Then the internet (arbitration clause). The credit cards (arbitration clauses). The streaming services (arbitration clauses). The bank account (arbitration clause).

“Did you know that credit card issuers representing 53 percent of all credit card debt impose arbitration?” Medvalli asks. “Affecting over 80 million consumers? The Consumer Financial Protection Bureau documented this in 2015. Ten years ago. Nothing has changed.”

He bought the houseboat in 2027, anchoring it off a small island because even the mainland marina operators had arbitration clauses in their slip rental agreements. He grows vegetables, collects rainwater, catches fish. He communicates through the U.S. Postal Service, which he notes with satisfaction has no arbitration clause.

His sister, Margaret, visits once a month to bring supplies. She has spent 18 years trying to convince him to rejoin society.

“The Founders would be proud,” Medvalli tells her.

“The Founders used corn cobs,” she replies.

He takes the toilet paper.

Word of Medvalli’s stand has spread slowly through legal academic circles. Law students write papers about him. Constitutional scholars cite him in footnotes. A documentary crew visited in 2031—arriving in an arbitration-clause-encumbered rental boat—and produced a film that premiered at Sundance to modest acclaim.

Medvalli didn’t see it. He couldn’t sign the streaming service’s terms of service.

“It made you look only moderately insane,” Margaret reported.

The film sparked a brief national conversation about forced arbitration. Op-eds were written. Senators gave speeches. The FAIR Act—the Forced Arbitration Injustice Repeal Act, which would invalidate pre-dispute arbitration agreements for employment, consumer, antitrust, and civil rights disputes—was reintroduced in Congress. A hashtag trended for nearly six hours.

Then everyone went back to clicking “I Agree” without reading.

One letter stood out from the thousands Medvalli received after the documentary. It came from Gretchen Carlson, the former Fox News anchor whose lawsuit against Roger Ailes had been complicated by her employment contract’s arbitration clause. Carlson had found a legal strategy to circumvent the clause—suing Ailes personally under New York City law—and her $20 million settlement had helped catalyze the #MeToo movement. In 2022, she’d advocated successfully for the Ending Forced Arbitration of Sexual Assault and Sexual Harassment Act, which President Biden signed into law.

“Dear Dr. Medvalli,” the letter read:

I understand your fight. When I discovered what my arbitration clause meant—that I would be forced into the secret chamber of arbitration, and nobody would ever hear from me again—it was one of the darkest days of my life.

But I chose to find a way around it, to fight within the system, to change what I could. The 2022 law that lets survivors of sexual assault and harassment choose court over arbitration—it happened because of that fight.

You’ve chosen to step outside the system entirely. I’m not sure either of us is right. But I’m not sure either of us is wrong, either.

The law I helped pass was called “the biggest labor law change in 100 years.” But it only covers sexual assault and harassment claims. Wage theft claims? Discrimination claims? Safety violations? Still arbitrated. Still disappeared.

Maybe we need both approaches—people like me fighting from inside, and people like you refusing to participate at all.

Medvalli has the letter pinned to his cabin wall, next to a handwritten sign that reads:

THEORETICAL RIGHTS: 100%

PRACTICAL PARTICIPATION IN MODERN SOCIETY: 0%

REGRETS: COMPLICATED

“I am not a model to emulate,” Medvalli says, as the sun begins to set over Lake Huron. Another cruise ship—one of the small Great Lakes tour vessels—passes in the distance. “I am a cautionary tale.”

He is quiet for a moment.

“But maybe every person who clicks ‘I Agree’ without reading should have to look at me first and ask themselves: Is this the only alternative? Is the choice really between surrendering your constitutional rights and becoming this?”

He gestures at the houseboat, the island, the dog now attempting to mount my backpack.

“If the answer is yes—if the system has been designed so that the only way to preserve your rights is to withdraw from society entirely—then at least people should know that’s the choice they’re making. At least it shouldn’t be done in ignorance, buried in fine print, invisible and unexamined.”

Kai successfully mounts the backpack. Medvalli doesn’t apologize.

“He does that,” he says.

Federal Judge William G. Young once wrote that the rise of forced arbitration represents “among the most profound shifts in our legal history. Ominously, business has a good chance of opting out of the legal system altogether and misbehaving without reproach.”

Proponents argue that arbitration is faster and cheaper than litigation. The Chamber of Commerce claims consumers win more often in arbitration and receive comparable awards. But these arguments ignore what researchers call “the denominator problem”: they examine only the tiny fraction of claims that make it to arbitration, not the 98 percent that disappear. They ignore the repeat-player advantage that systematically favors corporations. They ignore that a system designed to be fast and cheap is worthless if it deters virtually all claims from being filed.

The Seventh Amendment guarantees the right to a jury trial in civil cases. The Founders understood that this right served as a critical check on concentrated power. When corporations can compel their employees and customers to surrender this right as a condition of employment or commerce, they have effectively nullified a constitutional protection for the vast majority of Americans.

TooToo Medvalli knows all of this. He has had 18 years to read about it, think about it, write letters to congressmen about it.

None of it has changed anything.

As I motor back to the mainland, I pass the spot where the buoy used to be—the one Kai allegedly sank. The sun is setting, painting Lake Huron in shades of orange and pink. It is, objectively, beautiful.

My phone buzzes. A notification from my bank: updated terms of service. Would I like to review them?

I think about Medvalli, alone on his houseboat, communicating through letters, preserving his theoretical rights while the world clicks “I Agree” around him.

I think about the 60 million workers bound by arbitration clauses. The 300 million telecom subscribers. The 80 million credit card holders. The 98 percent of claims that simply vanish.

I think about whether rights that can be forced-waived are really rights at all.

Then I click “I Agree” without reading.

I have a mortgage to pay.

Oskar Rausch is a researcher at the Make America Constitutional Again Institute (MACAI) in San Juan, Puerto Rico. He can be contacted at oskar.rausch@proton.me

Editor’s Note

The statistics cited in this article are drawn from peer-reviewed research, including:

  • Alexander J.S. Colvin, “An Empirical Study of Employment Arbitration,” Journal of Empirical Legal Studies (2011)
  • Cynthia Estlund, “The Black Hole of Mandatory Arbitration,” North Carolina Law Review (2018)
  • Katherine V.W. Stone & Alexander J.S. Colvin, “The Arbitration Epidemic,” Economic Policy Institute (2015)
  • Consumer Financial Protection Bureau, “Arbitration Study: Report to Congress” (2015)

Dr. TooToo Medvalli is a fictional character who first appeared in “Cruise Ship Doctor” (2025). This article is a work of satirical fiction. All constitutional principles cited are real. All absurdity is intentional.

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