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!
And then my friend fell into the the infamous doughnut hole. Here’s an early victim of the recession, a woman who’s been living very modestly on social security and maximizing opportunities to serve as a substitute teacher, and shortly after she’s been discharged from the hospital, she learns that she’s staring into the financial abyss of the doughnut hole.
Where is she going to get the $2000 she’ll need to pay for meds before insurance kicks in again? The stipend a worker who can’t work receives from Workman’s Comp is more symbolic than supportive. Her social security credits from a career in education and social service are minimal. But the meds are essential if c. difficile is to be knocked out once and for all.
You think this is bad? There’s worse.
Look again at that photo of a once sturdy, once healthy woman still using a walker nearly four months after sustaining a playground injury. Which leg, do you judge, is keeping her from driving, from walking, from resuming a normal life? Wrong! Not the leg with the incision scar. The other one, the one that looks good but isn’t so good. It’s actually swollen a bit. In fact, she can hardly use it. This is the other gift from the hospital stay, the other consequence the hospital wants to slough off and Workmen’s Comp doesn’t want to pay for and Medicare doesn’t want to be stuck with.
To keep this explanation as simple as possible: a wrongly dosed medication caused a slow internal bleed which hardened into a hematoma pressing on the right femoral nerve. By the time the condition was diagnosed, the hematoma couldn’t be quickly dissolved, though eventually it should be reabsorbed. Meanwhile, my friend has been deprived of the use of her right leg, which can barely sustain weight, let alone locomote, etc. Would it could kick every irresponsible hospital administrator and insurance skinflint in the U.S. health care chaos!
Naturally any limb deprived of motion for many long months needs the services of rehab specialists to bring it back to normal functioning —but the Workman’s Comp people have tried to argue that the problem in the right leg has nothing to do with the break in the left leg. They won’t pay for two-leg therapy! At least, they are trying to wriggle out of it. The terror of all Americans, the specter of pre-existing conditions, has also been introduced. So far, evidently, nothing in my friend’s medical records will sustain a denial of treatment.
And speaking of records, here a photo of the papers pertaining to about half of the medical and surgical consequences of that broken leg. Looks like a ream-sized box or about 500 pages. At least. My friend has been sorting through all these records in order to support her claims. Imagine the hours it has taken her. How exhausting it must be, to one who is still debilitated from the near death experience of being treated in an insanitary hospital.
Not Tort Reform. Total health system reform, please.
If there were a decent health care system in the United States, my friend wouldn’t have to fight hospital and insurers for the cost coverage she deserves for the care she needs. If we had a decent health care system in the U.S., hospitals would be cleaner, too. During my visits to the hospital to see my friend, I was shocked by the general slovenliness of the rooms, which were so cluttered it would be impossible to keep them truly clean, and by the difficulty of washing my hands properly and conveniently.
If I were she, I’d sue the hospital. It's still possible, since conservatives have not yet managed to snatch the right to sue for damages and pain and suffering from from us. If hospitals won’t rigorously enforce good sanitation for the proper humanitarian reasons, it seems to me, we need to be able to force them to do so for fear of bankruptcy.
But my friend is nicer than I am.
And, oh yes, about costs. With single payer coverage for everyone, imagine how many thousands and thousands of dollars would be saved on paperwork---including salaries (and benefits, ho!ho!) for those tasked with finding ways not to pay claims or with avoiding responsibility. Maybe the hospital would devote more effort to cleaning the place up, too.