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Do you think in some extreme cases, rather than let a person go completely off the rails, God may sometimes physically remove the person from the earth?

Yes, absolutely. In fact, I think that is exactly what John is talking about when he discusses praying for someone to be healed but that when the person has committed a "sin unto death", God may not heal him.

If any man see his brother sin a sin which is not unto death, he shall ask, and he shall give him life for them that sin not unto death. There is a sin unto death: I do not say that he shall pray for it. (I John 5:16)

This is one place where Catholicism gets the idea that there are "mortal" sins, mortal meaning "subject to death? I disagree with their interpretation since ALL sin makes us subject to death and that is why Christ died in our place to make atonement for our sins.