Friday, March 20, 2009

Ain’t no caring in much of our healthcare

WTF—I guess that is a bit strong, but it communicates my feelings after a call I got last night from a friend of mine. What is with healthcare providers?

I know this guy (granted most stories that start out that way don’t go well, but this isn’t that kind of story) who crashed his dirt bike (or was it an ATV?) and broke his leg a few weeks ago. Young guy in his 20s, healthy, unemployed and with no health insurance…

He had done work on his vehicle in preparation to sell it. He took it out for one last ride to make sure all was well for the sale, but crashed instead, an accident. The crash resulted in multiple fractures to one of his legs. He went to the local ER, got splinted and told that once the swelling improved and they were certain it wasn’t infected at the time of the trauma they would do a surgical repair.

Back to the hospital he went 2 days ago, they loaned him a wheelchair, called a medi-van, and took him to the local orthopedist’s office. The orthopedist said that, indeed, he needed surgery for repair of the injury (and for the best outcome) and as soon as he came up with $30,000 cash he would be more than happy to do the surgery. The guy I know doesn’t have that much, so out of the office he went (with the wheelchair).

A friend of his suggested that he go to another hospital, surely they would see that he get the needed care. A young guy ought to have the treatment he needs so his leg can be the best it can be after it heals. He may need his leg to work, if a job becomes available. He might not want to spend the rest of his life in chronic pain nor with impaired mobility from suboptimal care and healing.

He went to another hospital, one his friend thought would surely help. He presented in the ER, because he had no other access to care. He was told (I am sure in a very caring way, they are a caring medical center, so much more than just a hospital) that if he paid 100% up-front they would be more than happy to give him the care he so obviously needed. There was nothing they could work out, there were no options, there wasn’t any real access to care. WTF.


Kathleen said...

What a sad commentary. It is the "business" of healthcare. It wasn't always like that. I remember charity hospitals very well. I also remember patients being sent away from emergency rooms, mid heart attack because they had no insurance, and taken (if they made it) to a hospital that accepts the uninsured.

Ellen Beth Gill said...

Cook County has a public hospital. Recently my mom said, I guess if an uninsured person needs to, he or she should go there (not at all meant to insinuate that was a replacement for access to affordable coverage). I said I wasn't so sure about that. Can an uninsured Lake County resident go to any particular place in Lake for help? Can he or she go to Stroger in Cook?

Anonymous said...

Something is not right and it's not the medical system. I think your friend is not telling all of the story if you are in the US. It is against the law to refuse emergent treatment to an individual. WE see it all of the time. Indigents abound in the ER room and are treated. Especially if they have a broken leg. That would be considered an emergency if only for saftey sake. hosptials allot for charity. What state is he in? He should return to the ER and ask for treatment and he will not be denied if they can offer him the services. No one wants to see him disabled for the rest of his life. That is far more expensive to the system than fixing a broken leg and the government realizes that. medicaid provides emergency medical care one time until stable to those that don't have money. Even when they are illegal. Now, you are telling us that your friend was denied medical treatment in an emergency situation because he couldn't pay his bill? Something is either mis understood or not right because the ER should have repaired the break and then sent him home. My thought is it's possible he had a break and they supplied him with a fiberglass boot to stabilize it and then he went to the ortho surgeon and was told how much it is. He just needs to return to the ER and state that he couldn't find a physician to treat. They will provide treatment to him. Can you please keep us informed with what happens? Oh and, I wouldn't lend any money to him until I had the entire story. Something doesn't quite sound on the up and up.

Dr. Richard Keller said...

Lake County does not have a County hospital like cook.

The Lake County Health Department Clinics and HealthReach can provide most Primary Care, but access to specialty healthcare and surgery is severely limited. Medical and surgical matters needing high level (tertiary) care (e.g. some neurosurgery or transplants) also have little or no local access to care.

In my prior employ, we used to refer folks (first openly, then more surreptitiously as they cracked down) to Cook County, but they now turn away folks from their clinics who do not have Cook County addresses.

Dr. Richard Keller said...

To anonymous:

This csae occured in Illinois and is really not that unusual.

The only treatment required in an ER is stablization, not definitive care. In this case that would involve (and did involve) splinting and referral for definitive care 9surgery by an orthopedist).

I know ER care mandates, I worked in ER Medicine over 17 years. I also worked in the Lake County Health Department clinics for 9 years and ran a free medical clinic 12 years. I saw this sort of thing all the time and it continues to happen.

It would seem the misunderstanding is on your part, but thanks for sharing your thoughts.

Ellen Beth Gill said...

Thanks for the answer, Dr. Keller. As to the use of an ER, I've been to the ER a couple of times. Each time they ask the first question, "can we have your insurance card?" I've been lucky enough to have one, so I don't know question no. 2 if the answer to question no. 1 is "I don't have one." However, I have been looked at in th ER and told to see my regular doctor the next day because they can't really do anything in the ER for my symptoms. Once I was admitted for a test because they weren't sure I didn't have a more serious problem. Would that have happened if I was uninsured at the time? I sort of don't think so.

So, I've been lucky, having insurance and a doctor to go to. What about the person who isn't? I've seen a person turned away from the medical group my doctor works at for lack of insurance. She told them she could afford to pay cash for the visit, but (at least it seemed to me from what I heard) the doctors in the group seemed afraid to see her in case they found that she had something questionable that medically required tests, or something more serious that required additional treatment. At that moment, I got a shiver realizing that the insurance card was not just payment, it was sort of an entrance/members ID. Without it, you can't even get in the door even if you can pay cash for the visit.

On the other hand, my cat has never been turned away from the vet.