I'm sure many readers have been horrified by headlines blaring that a Baltimore hospital allegedly "abandoned" an older and/or indigent patient at a bus stop in freezing weather. Unfortunately, the reality is likely to be very different to what's being presented by the news media.
Under the 1986 Emergency Medical Treatment and Active Labor Act, popularly known as EMTALA, any hospital accepting Medicare funding must provide emergency medical assessment to anyone, irrespective of their ability to pay. The law is very specific in its requirements - but it makes no provision for funding those requirements. Basically, hospitals are on their own. If they don't provide the required facilities and/or investigations, they can be stripped of Medicare funding. If they do provide those things, it's on their own dime - which is one reason why hospital charges have skyrocketed since EMTALA was introduced. They're not charities. They've got to cover those costs somehow - and our politicians weaseled out of paying them out of government funds, by forcing the hospitals to recover them from all their other patients. In so many words, EMTALA is blackmail, forcing hospitals - i.e. you and I, their other paying customers - to pay for what the government is not willing to fund.
As inevitably happens, indigent people have learned to "game the system". I've been on duty as a pastor and a volunteer in emergency rooms when such people come in, loudly complaining of this or that or the other imaginary ailment - usually something that's hard to quantify or assess. When tests are inconclusive, they demand to be admitted, fed, and treated like guests at a hotel, without paying a penny for it. Sometimes hospitals are forced to comply, particularly in cities where social justice warriors make it very difficult for them if they don't. In other cases, particularly when they're swamped with truly ill people, hospitals simply can't cope. They're forced to turn away such people - and if they won't leave voluntarily, they have to be evicted. That's one of the functions of hospital security staff. It happens on a daily basis, across the country. There's nothing unusual about it.
In the case in question, we don't know exactly what happened; but I'm willing to bet the lady's "symptoms" could not be adequately assessed, and medical staff had concluded that there was basically nothing they could do to help her. If she then refused to leave, because it was cold and nasty outside, what was the hospital supposed to do? Allow her to take up space and facilities required for someone who truly needed them? That's not on - so they probably tried to move her on in the most human manner open to them. The hospital is not a charity, and not a shelter for the homeless. It can't be. It has to serve its primary customers - patients - not the indigent. This makes a lot of people uncomfortable. I'm sorry about that . . . but it remains the truth.
Aesop, who works in an ER, points out (rather profanely - I've had to censor his post to reproduce it here):
This only happens about daily to weekly in every ER I've worked in, going back a mere twenty years, especially from October to March.
And the ****wits that complain about this kind of bull**** without knowing their ***** from a hole in the ground can't figure out why they're still sitting their fat ***** in my waiting room 6-8 hours later, because I can't get a fat troll like this to put on her clothes, gather her forty-seven shopping bags of ****, and GTFO so I can decon her room and see a real patient, until three security guards and two techs "help" her hit the bricks.
And if she had met the criteria for a mental health hold, the same ***holes would be bitching that she was incarcerated against her will and her civil rights violated for keeping her in the hospital.
Damned if you do, damned if you don't ... Thank your congress ****weasel for voting EMTALA into law.
Discharged?
She should be chained up in leg irons, and forced to shovel snow on the public roads to pay her bill and fine and cover the cost of green bologna sandwiches, in lieu of six months' jail time.
There's more at the link. He's largely right. I've been there, and seen it for myself.
Whenever you see a hullabaloo about hospitals allegedly "dumping" patients, ask yourself why any sane, normal person would do that. A sane, normal person wouldn't. Neither would a sane, normal hospital. They're doing it because they're caught between a rock and a hard place, thanks to EMTALA and the refusal of our politicians to pay for care for the indigent. They'd rather blackmail hospitals into doing it "free" - meaning, at our expense, because we're the ones ultimately picking up the tab.
Peter
One particularly bad weekend I spent 34 hours in the hallway of the emergency room sitting next to my wife's (in for an infected gall bladder that was turning septic) gurney waiting for a bed to open upstairs.
ReplyDeleteYep, it was a cold weekend, and the beds were full of homeless and bored people (as described by the head nurse of the ER to me.)
Seen it just about every time I've been in the ER for the wife. The drunk homeless that are getting deloused and new clothes, the bored singles (usually older, and much older) looking for just someone to pay attention to them, and so forth.
Then there's the family that get a member admitted for spurious reasons so they can all sit and watch free tv in an air conditioned room during summer heat waves. No, not joking at all. Same family will be in and out 2-3 times a week, usually with a huge spread of fast food.
I spent 22 years as a paramedic, and I can attest to what you are saying. We had what we euphemistically called "frequent flyers," who were transported so often that the medics in that zone knew their names and had their social security numbers memorized.
ReplyDeleteThere were 5 of them who we transported more than 3,000 times in one year (combined).
If PT Barnum could come up with "THIS WAY TO EGRESS" and lure people out of the show, surely the more clever hospitals can come up with a nice maze system that offers a sign to "FREE HOT MEALS" leading to a windy corridor, several self closing fire doors and naught but an exit at the end. If they could put it on the 3rd floor it might cut down on repeat visitors looking for free meals.
ReplyDeleteThis is a hospital run by the University of Maryland, which has along with Jobs Hopkins, taken over almost every hospital in Baltimore. This occurred at the mid-town complex, home of the Shock-Trauma unit, that started the air-lift ER system of emergency treatment.
ReplyDeleteThe woman was also extremely Bi-polar, not able to function at all mentally. The staff walked her out the FRONT DOOR (far from the ER) and left her on a bus stop kyosk, in nothing but socks and hospital gown, in temps in the teens. No purse, no cash, how was she gonna catch a bus? The man who shot the vid, a mental therapist leaving his office across the street, saw the employees leaving her at the bus stop, and took action. Otherwise, she would NEVER have been able to get a bus, and wound up frozen to death. I worked at a state mental hospital in Md, know how the system works, (poorly, at best) and if the gentleman had not taken action, she was dead, plan and simple.
And then there are the really sad idiots, those coming in for their nightly dose of NARCAN. Some of them come in every night on the ambulance, until, well, they don't make it in and end up at the coroner's office.
ReplyDeleteRight before Christmas, wife went in to ER for an allergic reaction to Lisinopril. While there, guy came in on the NARCAN train. 12 hours later, same guy came in on the NARCAN train.
Talk about a waste of resources. Many of these slow suiciders take up lots of time and materials, which will go to waste pretty darned soon as they slab themselves.
What’s the answer Pete? If the gubbimint is forced to pay - you’re back to ObuttholeCare or some other grossly overpriced version of it. That would mean a substantial kick in the nads at tax time too.
ReplyDeleteApplying my vast intellect to the problem: why not build a separate gubbimint funded ‘pi** tank’ to store the vagrants, rubbiedubs and turdies that abuse the system? It would be warm and dry and give fast access to them if they actually do have a real ailment. Give it a flowery name as some kind of Outreach Program, and posturing SJWs would even probably privately fund it...
I've experienced the ER price increase first hand having had to use them three times in my life. The first time was in 1976. I was working a graveyard shift and took very ill(turned out to be the flu). The only doc available at 3am was at the ER. I was seen right away, treated, and billed in the neighborhood of $35. The next time was in 2008 when my blood pressure went through the roof on me. In spite of having a SERIOUS condition, I had a long wait folks who looked fine went ahead of me. The bill this time, after Blue Cross, came to about $1000. The third time(2010)was a bit better. My problem could have been treated at my doctor's if it hadn't been after hours. Since it was a rural hospital this time, my wait was shorter, bit the price tag was about the same. Thanks a bunch EMTALA.
ReplyDeleteThe mental health system has been riding on a bent axle for years. The time to fix it was when the Cowboy was in office - and he infamously didn't.
ReplyDeleteThe biggest trouble with the ER system is that it catches everything that happens after hours, and probably a third to three-quarters of the people in the ER really don't have an emergency - an emergency being 'I can't breathe!' or some variant thereof.
The real solution is to provide an urgent care facility that operates 24/7 and features dentistry services. Alongside that, build a people friendly shelter that accepts dogs and cats. Walk in, and you can get showered, deloused, and given a clean set of clothes. You can get a standard box meal to include one apple, two sandwiches, one bottle of water, one bag of potato chips, and one pint of vodka. If you're quiet, you can get a cot in a warm, dry room for 8 hours. Your dog or cat gets veterinary care and food.
Now I, personally, care more about the welfare of the dog than I do about the owner, but that's just me.
And so, Voilà!, as they say in some countries. The ER now has legitimate patients mixed in with a few drug users, and a portion of the money the U.S. is now spending to support a supercarrier gets diverted to a more worthy cause.
Mad Jack,
ReplyDeleteI'd rather we fund the supercarrier. And that is part of the Government as envisioned by the founders.
Social Programs? It has been proven time and again that Church-run programs are more efficient, both in the work they do and in their fiscal responsibility, than government-run programs. Note-the big Non-Government Organizations (NGOs) like United Way and March of Dime types are corruption-riddled poop-piles where only a minor percent of the incoming funds are used for the stated goals. Local organizations or Salvation Army are much better at achieving true help for citizens.
Hospitals suck!!!!!
ReplyDeleteThe times I had to be hospitalized I rarely got any sleep or rest because I was constantly woken up at all hours of the day and night by the on-duty nurses who constantly needed to do another blood test, or to change bags or whatever.
And just laying there for a week or two, never getting any exercise to relieve tension, I got extremely antsy and edgy, also making any kind of rest or relaxation near impossible.
And the hygiene level is nothing to write home about either. For example, the staff often do not rinse out the urine bottles after emptying them---simply returning them to the patient for further use.
The reason one is normally hospitalized is on account of illness or injury, meaning the stay is bound to be most uncomfortable. For example, if one is having an abdominal surgery all one ingests is potassium-infused IV fluid----no food or drink. Often for a period of a week or better.
Hardly synonymous to a stay at a nice hotel room.
Dear JohninMD
ReplyDelete1) Consider the BS flag thrown.
Point by point:
This is a hospital run by the University of Maryland, which has along with Jobs Hopkins, taken over almost every hospital in Baltimore.
What's your point? That a competent, world-class hospital system did this?
This occurred at the mid-town complex, home of the Shock-Trauma unit, that started the air-lift ER system of emergency treatment.
See above.
The woman was also extremely Bi-polar, not able to function at all mentally.
False.
Bi-polar doesn't mean you can't function mentally.
It means you have labile mood swings.
And clearly she wasn't in any emergent crisis of same, or she'd have been admitted.
The staff walked her out the FRONT DOOR (far from the ER) and left her on a bus stop kyosk, in nothing but socks and hospital gown, in temps in the teens.
That the staff walked her out at all speaks volumes. It means they had to evict her, because she wouldn't leave voluntarily.
Also, I've consulted the relevant medical texts, and no where does it specify your clothing choices are a medical problem, let alone one requiring emergency treatment. If she'd gone comatose from exposure, and then been refused care, you'd have a point. She didn't, and wasn't, so you don't. Thanks for playing.
No purse, no cash, how was she gonna catch a bus?
Hypo-cashemia is also not a medical problem, let alone an emergency.
If she needed a wallet transplant, they have these things called jobs. Perhaps you've heard about them?
The man who shot the vid, a mental therapist leaving his office across the street, saw the employees leaving her at the bus stop, and took action.
2) Dogooder was a therapy student, the "employees" were security personnel and ED staff members, and his sole "action" was shooting the video, and posting it to Faceblab. Actual "action" if he'd been so "concerned" would be to take her home (hers, or his own), or buy her a coat, or something besides getting all offended by a situation about which he knows Jack, and Squat. Which defines the typical SJW "therapist" to a "t". Read the parable of The Good Samaritan, and quote me the verse about where the Samaritan got all butthurt and raised a stink, rather than actually, y'know, doing something. I'll wait while you look it up.
cont.
cont.
ReplyDeleteOtherwise, she would NEVER have been able to get a bus, and wound up frozen to death.
This is why most people, when discharged, take the opportunity to say "thanks", shuffle out to a pay phone, and call a friend or family member to come pick them up, rather than becoming such an odious jackhole that security has to "help" them find the front door. Play stupid games, win stupid prizes.
I worked at a state mental hospital in Md, know how the system works, (poorly, at best) and if the gentleman had not taken action, she was dead, plan and simple.
I'm looking for a downside there.
No, really.
But if she got to the stage of hypothermia and catatonia, she'd at least have a legit medical problem at that point, besides wanting "three hots and a cot", and no identifiable medical emergency, and would have been admitted at that point, and placed on a mental health hold for being gravely disabled.
Your hero took no "action", besides getting a red rash of butthurt.
As it turned out, the evicted patient in question is now back with her family (who probably previously turned their backs on her, and were nowhere to be found while she was inside the ER), because now they have a never-ending stream of ambulance chasing shysters telling them there's the potential of a big lotto cash payout.
My original assessment of her needing leg irons, a shovel, and close personal supervision in working off her debt stands.
She had 25-40 years to get a job, and earn enough to buy warm clothes for a cold winter.
If she's too crazy to hold down a job, she's getting ample for same from the public dole.
If she's too crazy to acquire the items anyways, she needs to be institutionalized, and live in a soft-padded place where the staff can feed her, water her, and turn her towards the light, and keep her safe and warm and dry.
None of those are the job of anybody's emergency department, unless she was so mentally bankrupt she needed to be placed on a mental health hold.
Nowhere, in any report of the situation, is anyone (not even her family) suggesting that she was so crazy she should have been held in the ER against her wishes.
Failing that criteria, and lacking any further medical reason to keep her, "it's cold outside" fails the rationale for failing to discharge her, because doing so at that point would be medical malpractice, insurance fraud, false imprisonment, and multiple other felonies.
Maybe where you used to work they wink at little things like that, but at most ERs I've worked in, TPTB in both administration and government tend to frown on such callous disregard for the laws of the state.