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Wednesday, July 4. 2012

1. Overheard from a wise old(er) RN in the ER this morning, "She's dying. Let her be."

2. Hospital bill for one of my patient's daughters for a 3-day ICU stay after an overdose: $124,000 (not including the bills from the numerous specialists who consulted on the case). That's the price of high-tech combined with tort fears. Tort-sensitivity prevents common sense in medicine, and results in rigid one-size-fits-all (expensive) protocols.

3. One-day ER bill for a stumbling drunk on the street brought in by the police after shouting to strangers that he was going to throw himself in front of a car: $3200. One wonders what happened to good old drunk-tanks at the police station. ER staffs prefer that drunks and addicts intoxicate themselves quietly without drawing attention to themselves.

4. An OR friend emailed me this pic of a nurse friend posing jauntily with surgical sponges. People have to have a little fun and humor in the OR. Fighting over what music to play is sometimes the most fun. Every OR has its CD player. Generally, the surgeon picks unless he or she is feeling especially generous towards the anesthesiologist or the nurses. Surgeons who want opera drive everybody else crazy.

Posted by Dr. Joy Bliss in Music, Our Essays at 15:37 | Comments (8) | Trackbacks (0)

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Liability/lawsuits. Drunks/druggies all brought to ER to make sure there is nothing ELSE wrong with them, because if something happens to 'em in the jail, it's a big clusterf*** for the police and the City's finances. The problem is, drunks do have other medical problems and are at risk for any number of things that can cause them to die suddenly. Same for overdose victims.

I don't know the easy answer, but I will say that there are a lot of drunks/druggies that have numerous ER visits for the same thing. It gets tiresome to see those same folks, who are running up that never-to-be-paid tab (and no, Obamacare will NOT fix this. In fact, somehow, I suspect that a lot of the chronic alcholics and drug addicts will still not have insurance and strangely enough, will not get penalized/taxed for the lack of it, either. Now, they just give false names and addresses, or even if they give their real ones....the hospital can't go after these folks, they only go after those who are accessible.

I think we need some kind of "3 strikes and you are out" rules, but I don't see it happening. Remember, there is NOTHING in Obamacare that attempts to deal with the problem of lawsuits and liability issues. Or there might be, but it was something like a committee to study a group who sponsored a committee to have some meetings to look at the ceiling and talk about what to do about liability issues....but they could only meet on Tuesdays in months with 29 days...something like that.

#1 Mo on 2012-07-04 15:59 (Reply)

Agree, Mo. I used to volunteer with a program in a top level adult ED to keep the revolving door twirling at a slower rate. Somehow, the PD used to know when to sweep the homeless (and often, alcohol-addled) citizens off the street and into the emergency room - we'd have big rooms set up for them. This usually occurred just before the alumni or graduation weekends of a Big Name local university. That police chief must be psychic!

#1.1 steve in ct on 2012-07-06 12:37 (Reply)

use the "take no prisoners" rule (the kind that Breaker Morant didn't quite understand).

if you take them in, you have to get them medical attention or care for them according to the Rules. if you don't let them surrender or don't arrest them for being drunk, they take their chances.

#2 wirraway on 2012-07-04 16:25 (Reply)

Mo, you know you can't sue a government-owned health-no-care system, especially one like Obama's regime is building, and win. Tort reform in that sense is built into the ACA. How often have you heard of a service member suing the base hospital, or a veteran suing the VA or a Medicaid patient suing a public clinic? Not often, I'm guessing. Remember, teh IRS is running this scam, so sue to your heart's content, if you can find a lawyer to take the case or a judge to hear it. Screwed we are, without an aspirin or a bandaid: no appeals, no options, no second opinions. Death panels.

#3 twolaneflash on 2012-07-04 17:19 (Reply)

How much of that $124K hospital bill is genuine and how much of it is cost shifting?

#4 Agent Cooper on 2012-07-04 17:30 (Reply)

After several years of working the night shift, I am no longer surprised at the number of people who use the ER as their primary care physician. We usually get 2 or 3 patients every weekend that are there for urinary tract infections. These people aren't going to go to a physician; they might have to wait and there isn't the excitement of going to the ER in the middle of the night. Teenage girls will show up saying anything to get a free pregnancy test. "Parents" will show up with a sick kid on Saturday night and say "he has been sick since Wednesday". People show up at 4 in the morning or on weekends to have routine lab work drawn, in spite of an outpatient drawing station that is open from 6 am to 6 pm, Monday-Friday. I can't see these people becoming responsible all of a sudden. Going to the ER is part of their social life.

#5 jdgjtr on 2012-07-04 18:26 (Reply)

Ah, responsibility. Who wants to discuss responsibility?

#5.1 jma on 2012-07-05 09:19 (Reply)

The exorbitant bills are also due to the need to cover the uninsured, as well as the "hidden tax" of entitlement payments, which generally do not cover the hospital's costs.

The dollar amount on the bill is also a fantasy number: hospitals will be paid much less by the gov't or insurance companies according to their contracts. The only one stuck with the full bill is the uninsured patient.

Defensive medicine against lawsuits certainly does add considerably to costs as well. Once the payment panels such as IPAB are fully functional, they will refuse payments for such "unnecessary" tests and procedures (under "practice guidelines"), leaving the doctors and hospitals even more exposed to lawsuits. Don't stand in front of the exits: you may get trampled by doctors leaving the profession.

#6 Dr Bob on 2012-07-05 17:45 (Reply)

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Wednesday, July 4. 2012

Random medical things