A hospital resident, no less horrified, confided, “I can’t believe this happened to you.”
But it did. And neither hospital nor insurers want to take responsibility.
On May 1 a healthy substitute teacher was admitted to a hospital with a broken leg. She had suffered a very nasty compound fracture on the playground, and by the time the right bone man could be found to pin all the bones together, it was too late to send her home. She definitely had to stay the night—and then, because her leg was so fragile and attendant dangers were so imminent, doctors judged that she should be kept under observation longer, through healing and rehab. Look at the scar on her left leg. The incision was huge, more than 12 inches long. You can’t see the whole cut, but you can imagine why careful follow up was needed.
So far, so good. Then the horrors begin.
Two insurers are involved in this story: a Medicare Advantage plan and New Mexico’s Workman’s Compensation program. Neither insurer disputes claims for costs directly related to treating the break itself. But that's almost the least of it, and after that, the fights begin. The hospital doesn’t want to take responsibility for complications clearly growing out of the conditions under which the break was treated; the insurers don’t want to pay for the cost of treating the complications. Here is a an excerpt from a letter to New Mexico’s Workman’s Compensation program, which has been trying to shove the costs onto Medicare. Medicare will pay, if necessary. (This is one reason why selfish seniors are happy with the present medical system—which is pretty nice, for seniors.) In the letter my friend is arguing that all costs arising from the break and its consequences should be covered.
I found myself in a double room with a patient who defecated on her bed, herself, and the floor next to me three times during the night. The next morning I told the nurse that I didn’t feel “safe” in this room and that it was not sanitary. It was one-two days later [my itals.] that I was moved to another room, and subsequently to the inpatient rehab unit.Some days thereafter, she writes,
I got severe diarrhea and a fever and was diagnosed with a c. diff. infection. After a week and a half [in an isolation ward], the requisite 3 stool samples tested negative. I was discharged...with a prescription for three additional days of antibiotics.
That was May 26, nearly a month after she’d been admitted for a broken leg. By June 5th, she was back in the hospital. The c. difficile had recurred. Recurrence is common, evidently, but no one had prepared her for that. Soon after readmission, “the c. diff. infection went septic,” another not infrequent complication. She underwent an emergency tracheotomy and spent nearly a week in a virtually comatose condition.
During her three-times-in-all hospitalizations, my friend had to spend many many days in intensive care and isolation wards. Such treatment is extremely expensive. Neither insurer wants to pay for it. Each argues that the other is primary, as the lingo goes. Worse, both hospital and Workman’s Comp have argued that c. difficile exists in ordinary dirt. Thus, those horrendously unsatisfactory hospital sanitary practices and conditions notwithstanding, the hospital should be off the ethical hook and Workman's Comp off the financial hook.
As if my friend had suffered from the runs when she’d presented herself to the emergency room with a broken leg! As if she had been gardening during those few days at home when she could barely move around her apartment with a walker. She’d been to church once during that interlude, when home care was provided by a Workman’s Comp contractor. She’d been once to visit her orthopedic surgeon. But anything to avoid paying a patient's bills!
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