Dallas hospital bills woman who waited 19 hours and never saw a doctor [Chron] (Thanks to Chester!) (Photo: xxxlps)

The NYT has an interesting article about the movement to standardize the bracelets:

The goal is to prevent potentially dangerous mistakes, like giving the wrong food to an allergic child, or allowing a patient with balance problems to walk unescorted down a freshly waxed hallway. The drive was spurred, in part, by a notorious 2005 Pennsylvania case in which a patient nearly died because a nurse used a yellow band thinking it meant “restricted extremity” (don’t draw blood from that arm), as it did at another hospital where the nurse sometimes worked, when at this hospital it meant D.N.R.

While the new color-coding has been quickly embraced by at least 20 states and endorsed by the American Hospital Association, the purple bands, typically embossed with the letters D.N.R. to reinforce the message, are meeting with some resistance.

The nation’s leading hospital-accreditation agency, known as the Joint Commission, has expressed caution about the new system, citing concerns about branding patients by their end-of-life choices, or inadvertently broadcasting those choices to family and friends who have not been consulted.

The commission also said that children who do not understand the system had been prone to trade the wristbands like baseball cards.

Awwwwkkwaaarrrdd. The main takeaway for the consumer is that hospitals make mistakes, so it's a good idea to ask questions about the bracelets that they put on you and make sure that everything is as it should be. If something doesn't seem right, speak up for yourself or for your family.

Hospital Bracelets Face Hurdles as They Fix Hazard [NYT]
(Photo:Chester Higgins Jr./The New York Times)

Medical Bills You Shouldn't Pay [BusinessWeek] (Thanks to Eric!) (Photo: jgodsey)

Hospitals in Los Angeles and Orange counties submitted phony Medicare and Medi-Cal bills for hundreds, perhaps thousands, of homeless patients—including drug addicts and the mentally ill—recruited from downtown's Skid Row, state and federal authorities allege.

City attorneys began investigating after receiving reports back in 2006 that hospitals were dumping homeless patients on Skid Row streets. What they found, they say, was that some hospitals were using conditions such as dehydration, yeast infection, and exhaustion as reasons for keeping homeless patients in beds for "as long as three days" in order to maintain full patient loads and collect money from the government.

Agents arrested Rudra Sabaratnam, CEO of City of Angels hospital, and Estill Mitts, operator of a Skid Row health assessment center, FBI spokeswoman Laura Eimiller said. They were in federal custody and were scheduled to be arraigned Monday.

The city attorney's office said it filed a lawsuit against the corporate owners of the three hospitals — along with Sabaratnam, several doctors and others — in connection with the alleged scheme.

Representatives of the hospitals did not immediately respond to calls seeking comment. Los Angeles Metropolitan and the Tustin hospital are owned by Pacific Health Corp., and Los Angeles-based Intercare Health Systems owns City of Angels.

"FBI: LA hospitals used homeless in medical fraud" [Associated Press]
(Photo: Getty)

A doctor at the hospital, William T. Kumprey, was tired of seeing Farnam.

Farnam had been to the hospital several times in the last month or so. He had used his fake heart attack routine at Silk — an exotic lounge — at several restaurants and while getting out of various cabs.

The doctor told Farnam he would call the police the next time he caught him faking the clutch of death to avoid paying his bills.

Farnam let it slip that he had, earlier that very day, after a hearty meal for which he did not pay, absconded to Froedtert Hospital.

The doctor called police.

The 52-year-old faces nine months in jail and a $10,000 fine if convicted.

Cardiac arrest: Man faked heart attack when dinner bill arrived [Milwaukee Journal Sentinel]

Some highlights:

• Interest rates can jump to as much as 27.99 percent retroactively. That's the rate Chase HealthAdvance's zero-interest plan charges, for example, if you miss a payment or don't pay off the debt in the promotional period. By contrast, the average fixed-rate credit card charges 11.9 percent, according to Bankrate.com.
• Consumers report that they sometimes feel pressured by medical providers to finance needed medical care, in some cases while sedated or recovering from treatment.
• Doctors and dentists have financial incentives under these arrangements to encourage patients to sign up for more expensive treatments and to steer them to extended financing plans that take a smaller cut of the practitioner's fee.
• When hospitals persuade patients to tap unused credit, those patients can lose the power to bargain for discounts or even obtain charity care

Overdose of Debt [Consumer Reports]
(Photo: Getty)

Among the many hospital personnel who stopped in to see my father after surgery was a "financial counselor" from the billing office, who basically started stalking him from the minute he left the intensive care unit.

After making several unsuccessful visits to his room on Tuesday and Wednesday, she slipped her card under the door asking my dad to call her. A little busy recovering from major surgery, my dad didn't get around to it. So on Thursday, the woman called him on the phone in his room, waking him from a much needed painkiller-induced nap to demand a $1,500 down payment on his surgery.

Still connected to IVs, a morphine pump and creepy-looking blood drains, my dad had enough to worry about without getting hassled by the billing office, like dying from a blood clot, or acquiring a drug-resistant infection from the guy in the next room. (Family and hospital staff alike were visiting the guy barehanded despite a big sign on his door warning people not to come within three feet of him without gowns, gloves and masks.) So I went down to the billing office to complain. A supervisor informed me that the counselor was making a "courtesy call" to inform my dad of the limits of his insurance policiy, but she acknowledged that it was hospital policy to wrest as much cash as humanly possible out of patients before they leave the building.

I told the supervisor that hassling post-op patients was incredibly inappropriate, especially given that most of them were too doped up on painkillers to even sign a consent form, much less negotiate billing options. If the hospital had wanted to discuss payment issues, it could have done so when my dad pre-registered with the hospital two weeks earlier. After some perfunctory apologies and some lame excuses, the woman thanked me for the feedback and I left. Later a nurse told us another patient had also complained of a similar shakedown, and she said the nurses were horrified but powerless to do anything about it.

Disgusting, but emblematic of for-profit hospitals. Avoid them if you can.

Hospital Shakes Down Post-Op Patients, In Their Beds [Mojo Blog]
(Photo: Getty)

Since 2004, UCSF said it provided the names and addresses of 30,590 patients to Target America, paying the company $12,000 a year.

Hospital officials said it contracted with the company to assist "with identifying names of individuals who could potentially receive communications from UCSF."

"Identification of potential donors who were active in the philanthropic community was one objective, along with identifying individuals who had corporate relationships, such as board service, or were affiliated with relevant community programs and health care biomedical organizations," Kaarlela said.

After the breach was discovered, the hospital said it required Target America to hire "an objective third-party firm" to investigate. UCSF received the forensic analysis report March 26. It showed that information was potentially accessible from July 1 to Oct. 9 last year "if a query for a specific name was made." Notification letters were mailed to patients April 4.

To Dixon, the expert on medical identity, the disclosure lag was far too long.

"In Internet years, that's a century," she said.

In January, California began requiring health care providers to alert consumers if their medical information is breached. Swift notification is considered important so consumers can monitor credit reports and bills.

According to Joanne McNabb, chief of the California Office of Privacy Protection, notice should be given "in the most expedient time possible, without unreasonable delay."

"It's a judgment call, the how and the when part," McNabb said. "The idea is to give early warning so that people can take defensive action. On the other hand, you don't want to needlessly worry people."

It's not the worst case of lost records we've seen, but mining for donors seems so much worse than "whoops, lost another laptop!" At least people's social security numbers weren't included with the data. People who think their identity may have been stolen should pour themselves a stiff drink before sitting down to read this comprehensive post.

6,000 UCSF patients' data got put online [San Francisco Chronicle] (Thanks to Paul!)
(Photo: Getty)

Dr. Susan M. Trocciola, who was a resident in trauma medicine at the time, testified that she placed a finger in Mr. Persaud's rectal area after conducting a physical exam of his spine to check for a spinal-cord injury.
 
Whether the rectal exam was performed was a matter of dispute. Mr. Persaud testified that he felt a finger inserted in his rectum, but Dr. Trocciola said the exam was never carried out.

Mr. Persaud was not necessarily the most sympathetic plaintiff. It emerged during the trial that Mr. Persaud, a native of Guyana who did not complete high school, had been convicted of two misdemeanors: attempted aggravated harassment for making phone calls to an ex-girlfriend's mother in 2001 and criminal mischief for threatening a fellow motorist with a baseball bat after a minor car accident in 2007. Mr. Persaud had filed a workers' compensation claim and also sued the owner of the site where he was injured. He was awarded about $4,000 in the compensation claim, but the suit was settled for a negligible sum, Mr. Marrone said.
 
In a phone interview, Mr. Marrone said of his client, "He's not a perfect person, but he's not a criminal by any standard of the word. He's got a lot of anxiety. He reacts negatively in stressful situations and he has a short temper."

RELATED
"Doctor Forces Rectal Exam, Patient Punches Doctor, Police Arrest Patient, Patient Sues"
(Photo: Getty)

On March 15, my dad had triple-bypass heart surgery at Jewish Hospital in Louisville, Kentucky. My mother immediately started planning for his aftercare. My mother is disabled and uses a walker to get around; my father normally takes care of her.

My father's doctors, along with the hospital's case worker and my mother tried to get their health insurer, Anthem Blue Cross/Blue Shield to approve off-site cardiac rehab. They initially approved the request and made arrangements at an approved facility. The day before checkout, March 19, Anthem changed it's mind. My father's doctors kept him another day to execute an emergency appeal. But to no avail, Anthem determined my father was "too healthy" and would have to go home (and basically perform self-care). It pushed my mother to the verge of a nervous breakdown, but thanks to friends and neighbors they made it work. Anthem was kind enough to provide a visiting nurse, three times a week, even though daily care was recommended by the doctors.

Yesterday, they received the attached letter, approving the rehab stay. Well, great, right? Let's go to rehab! Well, no-no-no. The approval was only good until 3/24. So, he'll have to re-apply.

In a stunning development underscoring the plight of non-profit hospitals struggling with the increase in uninsured patients, the Catholic ownership of St. Francis Hospital & Health Center on Wednesday said it will shutter the hospital because nobody would buy it.

The religious order of nuns that oversees St. Louis-based SSM Health Care said it could not even give the hospital away to other health facilities "for free."

Saddled with tens of millions of dollars in losses from uninsured patients who could not pay their medical bills, St. Francis would be abandoning its core mission of caring "for the people of its communities regardless of their ability to pay." SSM will seek a closing application with the state, a process that could take several months.

The closing would erase a deeply established health-care facility in a struggling south suburban town, forcing residents to travel further from home and potentially stressing other facilities with an influx of thousands of patients, many with limited means.

"Unfortunately, in spite of St. Francis' outstanding clinical reputation, reimbursement from commercial insurers could not cover the cost of providing care to the growing number of Medicaid and uninsured patients," said Sister Mary Jean Ryan, SSM's chief executive officer.

Maybe a network needs a realistic set for a TV doctor show?

SSM to Close St. Francis Hospital & Health Center (Press Release) [St. Francis]
The hospital they just couldn't save [Chicago Tribune via WSJ Health Blog]

The error occurred in diagnosis before the surgery took place. The surgery staff followed all appropriate safety protocols, including marking the surgical site and pausing before surgery to confirm the final details.

Unfortunately, the side of the affected kidney was incorrectly identified in the medical chart several weeks before the surgery took place.

"The fact is, my kid has leukemia, and if he doesn't get this treatment, he will die," Robert Mitchell said. "The way they made me feel was that they were pressuring us to take him home and let him die. We'll try anything that has a chance of succeeding, and I will not give up fighting for it to be covered.

"Go to their Web site, and their mission statement says they treat each person with compassion," he said. "I think that's a bunch of hoopla."

Paul Tate, a spokesman for Primary Physician Care, said the company is not authorized to discuss Paxten's case.

(Thanks to Adam!)

"Insurance won't cover child's critical leukemia treatment" [Asheville Citizen-Times]

RELATED
www.primaryphysiciancare.com
(Photo of Paxton Mitchell: Citizen-Times)

Research has shown a link between sexualized images of teens in the media and mental health problems in girls, including eating disorders, low self-esteem, anxiety and depression, according to the Boston-based Campaign for a Commercial-Free Childhood.

(Thanks to Darkwing Duck!)

"Group: Hospital should nix retailer name" [BusinessWeek/AP]
(Original photo before it got corrupted: D'Arcy Norman)

The box "had a document indicating it was sold because the shipping company could not deliver it or find its owner," and UPS told MSNBC that it keeps undeliverable packages for at least 3 months before liquidating them. What we can't figure out is how three full months elapsed between early December, when the box was shipped, and the end of February, when the box had clearly already been liquidated and was being offered for resale by a private business.

(Thanks to Sarah!)

"Medical records sold to teacher as scrap paper" [MSNBC]
(Photo: Orin Optiglot)

Before even reviewing the picture, I heard a woman yell, "What do you think you're doing?!" I looked up, seeing an angry looking woman briskly coming down the hall at me.
 
"Taking a photo of the sun," I replied.
 
"You're in a hospital!" she shrilly declared.
 
"Yes, obviously."
 
"I've called security, you stay here!"

Kurt didn't stay there, but told her his father had been there for 3 weeks now and he was going to go join him at dinner.

And so I did. I joined my father at dinner. Within minutes, someone tapped me on the shoulder. It was a security guard.

"Sir, can you come with me?"

"Certainly."

"Were you taking photos in the hospital?" he asked, seemingly bored.

"Yes, I took a photo out the hallway window in the 3rd floor of the sun." I showed him the photo.

"Okay, just don't do it again. Thanks." It seemed like he was just a guy doing his job so I agreed and went back to sit with my father.

"See, they're all pinheads," commented my father.

He exasperatedly explained to me that I could not take photos anywhere on the hospital grounds because it violated the employees' rights. I was also told that I was not allowed anywhere but with my father. Failure to comply with these requests would result in being escorted by the still present security guard. At this point, he also demanded my driver's license as proof of the incident.

• to protect the privacy of employees;
• to protect the privacy of patients;
• to prevent situations where someone taking pictures may get in the way of helping the sick and injured;

It seems reasonable that those three needs can be met with a sign posted at every entrance that says something like, "Please do not take photographs of employees or patients. No cameras allowed in hallways or treatment areas." Hey, and then you could also tell employees to memorize and repeat those two restrictions one time only to offenders, along with "Hospital policy!" at the end. If they spy a repeat offender, they call security. Another problem solved! You're welcome!

In other words: We get that the hospital wants to protect the privacy of employees and patients, but obviously a simple explanation of the no-photos policy would have sufficed. Bringing two employees to twice interrupt a visitor's dinner with his father is the kind of overreaction that happens when you equate photographs with terrorism, and cameras with guns.

Kurt writes,

I wanted to point out that I didn't take a picture of any person, or that I couldn't possibly know their absurd policy since there was no signage posted anywhere. And if a search of their site is any indication, the only person who is aware of this policy is the the head of security himself.

We tried contacting Resurrection to find out what their official photo policy was, but we were transferred from the front desk to security, then given a number to guest relations that didn't work. (The security guy said it was probably closed for the evening.) Nobody we actually spoke with was willing to say anything about a photo policy for visitors.

This writer thinks there's another reason for all the photo banning currently in vogue: it's a superstitious attempt to retroactively prevent 9/11 from ever having happened. Letting a stranger shoot a photo has become a symbol of invasion and assault, of scheming and revenge. Or maybe it's also a fear of Flickr. At any rate, this writer half-seriously suggests maybe earmarking some public funds for a national re-education campaign about the moral neutrality of "Taking Photos."

"Hospital forbids photos of the sun!" [fiftytwofifty]

(Photos: security guard: Getty; seminar: kerryank)

Barbara later told reporters, "Luckily I had a $5 bill. I gave it to her."

Workers at Staten Island Physician Practice (SIPP) were appalled when they learned of what had happened to Mrs. Antonelli, calling it "insane" and "crazy."

"It's not our policy," said Sally Cohen, center administrator for SIPP, who was surprised that someone would worry about payment on the spot instead of billing the patient after the fact. She said she will investigate what happened and address the situation with the employee. "We're all in this for medicine. If it is an incident, I will take care of that."

Mrs. Antonelli's son, Thomas, rushed to RUMC after she was brought there and was stunned when he heard the story from his mother.

"She's on a stretcher and they're worrying about five dollars," he said, pointing out that if the receptionist was acting against policy, some of the other workers could have stopped her on her way out the door. "It's insane. When I go there [over the weekend], I'm definitely going to go in and find out who that woman was."

Doctor's office commits cardiac infraction [The Staten Island Advance via Gothamist]

The patient was taken to to the emergency room at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, given 8 stitches on the head, and was told he would need a rectal exam to see if he had a serious spinal injury.

He refused.

He adamantly objected to the procedure, he said, but was held down as he begged, "Please don't do that." As Mr. Persaud resisted, he freed one of his hands and struck a doctor, according to the suit. Then he was sedated, the suit says, with a breathing tube inserted through his mouth.

After Mr. Persaud regained consciousness, he was arrested, then taken — still in his hospital gown — to be booked on a misdemeanor assault charge. Gerrard M. Marrone, who was Mr. Persaud's lawyer, got the criminal charges dropped, then helped Mr. Persaud file a civil lawsuit against the hospital.

"Psychologically, it changed his life completely," Mr. Marrone said of the episode. "He hasn't been able to work. He has absolutely no trust in the system at all: doctors or the police. He has post-traumatic stress syndrome."

Forced Rectal Exam Stirs Ethics Questions [NYT]
(Photo:Getty)

According to Reuters, "the study found the largest racial disparity in providing stronger medications was found among patients in the most pain and those aged 12 or younger."

"There is no evidence that nonwhites have less severe or different types of pain when they arrive in the emergency department," Pletcher said. "We think our data indicate that opioids are being underprescribed to minority emergency department patients, especially black and Hispanic patients."

A factor may be that white patients are more likely to expect and demand relief from pain and better convey their symptoms in comparison to minority patients, the report said. Whites — who are more likely to have health insurance — may also be overprescribed the drugs, it said.

The investigators acknowledge that it is conceivable that the disparity represents overprescribing to white patients, but they think it a more plausible explanation is true undertreatment of pain in minority patients. This may not be a result of physician bias but could reflect expectations and assertiveness of the patients.

The results were stunning. Within three months, the rate of bloodstream infections from these I.V. lines fell by two-thirds. The average I.C.U. cut its infection rate from 4 percent to zero. Over 18 months, the program saved more than 1,500 lives and nearly $200 million.

A large body of evidence gathered in recent years has revealed a profound failure by health-care professionals to follow basic steps proven to stop infection and other major complications. We now know that hundreds of thousands of Americans suffer serious complications or die as a result. It's not for lack of effort. People in health care work long, hard hours. They are struggling, however, to provide increasingly complex care in the absence of effective systematization.

Excellent clinical care is no longer possible without doctors and nurses routinely using checklists and other organizational strategies and studying their results. There need to be as few barriers to such efforts as possible. Instead, the endeavor itself is treated as the danger.

RELATED
"The Checklist" [The New Yorker]
(Photo: Getty)

The basic advice is to wash, wash, wash. Practice good hygiene, wipe down surfaces and keep yourself clean when you're at the gym, take care of all cuts and scrapes and keep them bandaged, and make sure your children don't share their belongings with friends—especially since staph is hardy, and can be transferred down a long chain, e.g. from Mom who works at the nursing home, to her daughter, to your daughter, to the rest of your family. (Something similar to this actually happened to a doctor quoted in the article.) And above all, respect antibiotics; your bank account will thank you when you don't have to spend months trying to recover from an infection.

Without question, people need to show far more respect for antibiotics. Misuse of antibiotics allows bacteria to evolve and develop resistance to drugs. But parents often pressure pediatricians to prescribe antibiotics even when they don't help the vast majority of childhood infections. When you do take an antibiotic, finish the dose. Antibiotic resistance is bad for everyone, but your body can also become particularly vulnerable to resistant bacteria if you are careless with the drugs.

I recently contacted my deceased pet's (pictured at death) vet to request that they send me a series of full-body x-rays they shot about 7 years ago. While I haven't been able to speak to a doctor or head administrator yet, the receptionists have informed me that x-rays and other medical images of their animal patients are the legal property of the hospital. They can loan the images out to me for a month, but then I must give them back. This seems really odd."

First of all, I PAID out of pocket to have the x-rays taken. Second, the pet is deceased. There will be no need for any veterinarian to refer to those images ever again. Third, how can it be that I have full ownership rights to x-rays (that are paid for by my insurance company) of my own body, and yet I don't own rights to my pet's x-rays? There IS the possibility that, somewhere down the line, I signed a waiver of my rights to those images, but is it even legal for the vet to request such a waiver?

What's the real deal here? While I'm sure very few people ever ask for their dead pet's medical records, is there any chance you can look into this for me? How can I go about getting those x-rays in my hands?

Much appreciation from
the c-side

These plans often cap out at amounts far lower than the market cost of any procedure, or have complicated rules on pay outs—Aetna's new offering, for example, pays up to $7,500 a year for inpatient care, but limits the daily amount of a hospital stay to $250.

As our reader Laurel puts it,

They market themselves as a way for temp firms and other places with hourly employees to increase the perception that their employees are 'valued.' The employer pays little - sometimes nothing - for the 'benefits.' Payment is deducted automatically from employee payrolls.

My fear is that, with the push toward universal insurance, scam-scum like this will qualify as 'being insured,' leaving workers in the lurch if they become ill.

RELATED
"More Kansas Insurers Offering Limited-Benefit Plans For Employer-Sponsored Health Care" [Medical News Today]
"Wal-Mart has a limited benefit plan, called Starbridge." [old WSJ article, found through Google ]
(Photo: Getty)

The card provides APR-free financing for up to 36 months; there is a $25 fee for missed payments, according to the customer service rep we spoke with, but never an interest rate. Minimum monthly payments are $25 or 4% of your bill, whichever is higher.

CarePayment is provided through arrangements with hospitals, so you can't go out and apply for the card yourself. Usually a participating hospital will offer it to you automatically if they feel you will have trouble paying off your bill. Otherwise, you can contact your hospital's billing department and ask them whether they offer it. If your hospital doesn't offer it, you might want to ask them to look into it, as it's a good way for them to recoup money from the patients least likely to be able to otherwise pay their bills.

"Hospital Charge Card: Don't Leave the Ward Without It" [Wall Street Journal Health Blog]
(Photo: Getty)

Thankfully, there are a few things you can do to protect yourself from hospital acquired infections. Most of them require having the confidence to speak up.

From the Globe:

"Patients and their families have a role, too," said former New York lieutenant governor Betsy McCaughey, chairwoman of the Committee to Reduce Infection Deaths. "But too often, patients and families are reluctant to speak up. If you're worried about being too aggressive, just remember: Your life is at stake."

So how can you be an effective advocate for yourself or your relative?

It can mean paying attention to everything from when to get antibiotics before surgery (no sooner than an hour before), to the angle of the bed for a ventilator patient (30 degrees), to asking whether all those tubes are really needed (they may not be).

But doing that can require courage — and persistence. Dr. Denise M. Cardo, the top specialist on hospital-acquired infections at the US Centers for Disease Control and Prevention compared it with her own experience with car mechanics.

"I decided, because they messed up so many times, that I'm questioning everything," Cardo said. "What we want is a healthcare environment where people feel fine doing that, where they feel empowered to say, 'OK, why do I need that?' "

Patient, protect thyself [Boston Globe via WSJ Health Blog]

15 STEPS YOU CAN TAKE TO REDUCE YOUR RISK OF A HOSPITAL INFECTION [Rid]
(Photo:Getty)

New Jersey joins 20 other states that require hospitals to publicly report infection rates in one form or another, according to the advocacy group StopHospitalInfections.org. They also reported last week that new Medicare regulations have been passed that allowing Medicare to withhold payments to hospitals that infect patients. Visit their site to find out what's going on in your state and how you can help.

Earlier this year, we pointed out an online resource to compare hospitals, but even if you can't find out much info on your own, The Post and Courier of Charleston, South Carolina suggests you take the following steps to reduce your risk: ask lots of questions (it forces care providers to mentally walk through the proper steps), and pay attention to how your providers are dressed—neckties, long hair and jewelry are breeding grounds for bacteria.

Resources:
Report of current status of legislation on a state-by-state basis (pdf)
StopHospitalInfections.org

(Photo: Getty)

Since November of 2002, 122 of King's patients have filed suit claiming King injured them during surgery. From the Charleston Gazette:

King, who changed his name to Christopher Wallace Martin last year after claiming people were trying to steal his identity, did not appear at the Putnam County Courthouse during the trial, which began July 16.

Late Tuesday morning, before lawyers for each side made their final arguments in a packed courtroom, Spaulding gave the jury detailed instructions about how they should examine evidence in the case.

A critical factor, the judge said, was Putnam General's loss of all the original files about privileging and credentialing King.

"Putnam General had a definite duty to preserve it. But Putnam General failed to preserve the files," Spaulding told the jurors. "Because the hospital lost the credentialing files, you may infer that if the hospital had saved the original privileging files, it would have contained information that was adverse to them ... and favorable to the plaintiffs."
...
Before offering King a post, Curry added, Putnam General administrators promised to pay him $35,000 a month, as well as a $45,000 signing bonus, $15,000 in moving fees and $5,000 in advertising costs.

Hospital found negligent [Charleston Gazette via WSJ Health Blog]

[via NBC]

A malfunction in new computer software occurred July 2 and affected statements for 587 patients who were treated at Northern Cochise Community Hospital in Willcox, said Kim Aguirre, director of patient financial service for the hospital.

"The highest statement is $49 million," Aguirre said. "I can't wait to hear from that person."

Peta-Anne Tenney received a bill for more than $100,000.

"I just laughed," she said. "I said to (my husband), 'Look at this, this is a doozy.

The Tribune obtained the results during the weekend from the Association for Professionals in Infection Control & Epidemiology (APIC), which is releasing the report publicly on Monday. The author is Dr. William Jarvis, former acting director of the hospital infections program at the Centers for Disease Control and Prevention.

The findings come amid mounting public concern about the spread of antibiotic-resistant bacteria in health-care facilities and community settings. Medical experts consider the rise of so-called superbugs such as MRSA, a leading cause of deadly blood infections and pneumonias, one of the most alarming public health threats in the nation.

"We're hoping this survey is a wake-up call to health-care workers across America," said Kathy Warye, the association's executive officer.

It is the largest, most comprehensive survey of MRSA in health-care facilities to date. It's based on surveys sent last year to 10,000 infection-control practitioners, including doctors and nurses in hospitals, nursing homes and rehabilitation facilities.

All health-care workers should practice rigorous hand-washing, and all institutions should have robust programs for disinfecting medical equipment and patients' rooms, he said. When patients are known to have MRSA, hospital staff should wear gowns and gloves to prevent transmission. And patients deemed at risk of carrying MRSA should be screened to determine where bacterial hot spots are festering.

"Now that the true extent of this scandalously tragic epidemic is known, I hope that health-care leadership will finally confront it with the effective means that have always been available," said Michael Bennett, president of the Coalition for Patients' Rights in Maryland.

Staph infections rampant [Chicago Tribune]

The group, Geisinger Health System, has overhauled its approach to surgery. And taking a cue from the makers of television sets, washing machines and consumer products, Geisinger essentially guarantees its workmanship, charging a flat fee that includes 90 days of follow-up treatment.

Even if a patient suffers complications or has to come back to the hospital, Geisinger promises not to send the insurer another bill.

In Bid for Better Care, Surgery With a Warranty [NYT]
(Photo: Kalim A. Bhatti/NYT)

From the Hospital Compare site:
This tool provides you with information on how well the hospitals in your area care for all their adult patients with certain medical conditions. This information will help you compare the quality of care hospitals provide. Hospital Compare was created through the efforts of the Centers for Medicare and Medicaid Services (CMS) and organizations that represent hospitals, doctors, employers, accrediting organizations, other Federal agencies and the public.

The hospital we were born in does an excellent job of providing heart patients with smoking cessation counseling. Well, who knew? —MEGHANN MARCO

Hospital Compare [via Freakonomics Blog]

After hernia surgery, Mary Corfeld stayed overnight for observation. When she got the bill

It included $16 for four acetaminophen tablets, $4 for a single multiple vitamin, $49 for two breast cancer tablets that Walgreens sells for $9.93 each when purchased in a 30-day supply, and $13.98 for an antacid tablet that sells for $1.27. She also was charged her $258 for an asthma inhaler that costs $42 at Walgreens.

The rub comes because Medicare doesn't cover the costs of self-administered drugs taking during observational stays. This also means they can't regulate the practice. Defending it

Beth Earnest, a spokeswoman for Community Memorial, said the hospital's costs are higher. For example, the drugs are not simply taken from a large bottle, but are individually wrapped, she said

Evident ally, the solution is to hide some generics in your bag and refuse when the hospital tries to feed you one of these golden Tylenols. — BEN POPKEN

Pills for a premium [JS Online] (Thanks to AcilletaM!)

Stanford University hospital patients can expect to see on their bills new line items for office supplies and break room materials.

(Thanks to Bill!)

In discussing Tom's tale of insurance woe, several people quipped that we should have insurance for your insurance. You know, pay a small monthly deductible so that in the event of emergency where your insurance company refuses to pay up... CR, who works for a claims adjustment and management company, says:

"The only problem is getting that info to submit a claim is nearly impossible."

Moral of the story: don't get sick.

Bodily mutilation
Kafa references
Indomitable and persistent consumer
Victory, snatched from the jaws of defeat, snatched from the jaws of abject incompetence.

Here's a teaser line: "Then I got the surgery. Trust me, getting my face sliced up was the easy part."

Tom's letter, inside.

Tom writes:

"Hi -

This will probably be one of the better insurance stories you receive. But you gotta read to the end because this thing ends like a good book.

In March 2003 I scheduled surgery for nasal polyps (ok, that part of the story isn't very good). I called my insurance company, CIGNA, to get preauthorization for the surgery (or what they call a predetermination of benefits). I also requested and received a predetermination for the surgeon I was to use. Finally, I requested and received a predetermination for the hospital the surgery was to be performed at. In short, I did everything I could imagine to make sure I didn't get screwed by CIGNA.

I got the surgery in late March 2003. When I checked into the hospital, I provided my insurance information and listened while the hospital verified it with CIGNA, described the surgery and the surgeon, reviewed the treatment history, etc.

Then I got the surgery. Trust me, getting my face sliced up was the easy part.

Precisely 30 days later, I called the hospital to ensure they had been paid. They had not. So I called CIGNA to ask why. CIGNA assured me payment in full had been approved and was scheduled.

Thirty days later, same thing. Payment was approved, there are no problems, you have nothing to worry about, the bill will be paid.

Thirdy days later, same thing.

One week later I call again (the plan at this point was to call them every week, and then every day, until they paid). At this point, however, the story changed. As Donald Rumsfeld might say, goodness gracious did the story change. I was advised - 97 days after surgery, approximately 120 days since surgery was "pre-approved" - that CIGNA wouldn't pay one nickel of the hospital's charges. That hospital, they informed me, didn't participate in CIGNA's plan and was unauthorized. I was politely informed it would be up to me to pay the $9700 hospital bill.

The volume of telephone calls that ensued over the subsequent 9 months would take far too long to describe, so at this point I'll greatly condense things.

I contacted my doctor - was I crazy, or didn't he tell me his staff had verified all this stuff as well? His staff informed me they had. In fact, the hospital they used was the only one in the region with the medical equipment required for this surgery. It wasn't possible at any other hospital.

I called CIGNA back and told them. Well, yes, the CIGNA representative told me, perhaps we would have authorized treatment with that information, but you didn't provide it at the time.

I asked her, well, the doctor also confirmed coverage at that hospital. In fact, the hospital itself confirmed coverage before AND after surgery. We're not imagining this. We have names and times and badge numbers.

This, word for word, was CIGNA's response: "Well, sir, it was a clerical error. You know, mistakes happen."

A-ha, I thought. They admit it was their own fault!

I then called the Ohio insurance commission (the body that regulates insurance companies in Ohio). Very proudly I described the situation to a case worker. I proudly described CIGNA's admission that they had made a mistake, that it was their fault.

This, word for word, was the Ohio insurance commission's response: "Well, sir, it was just a clerical error. Mistakes happen."

Yes, I replied, but it was THEIR error, not mine. I was politely informed that it didn't matter - I still had to pay for it, not them. The only determination of benefits that matters, I was told, was the one they make when the get the bill. That is, AFTER the treatment has already taken place.

In other words, I did all my homework, crossed all my t's and dotted my i's, got badge numbers and predetermination-of-benefit codes, and made sure the hospital and doctor did as well - and none of it mattered. Not one bit. Nothing counts until they get the final bill. That's when a binding decision is made. In Ohio, there is no way to ensure a procedure will be covered before you undergo that procedure. This, somehow, constitutes "insurance."

Just to wallow in the Kafka-esque glory, let's recap: CIGNA pre-authorized everything. CIGNA even told me that since the hospital I used was the only one available with the necessary equipment, they would have approved it if I had told them that fact. But I didnt' tell them that fact because I didn't know I needed to, because they told me they would cover it regardless. And they admitted it was their error, and they were terribly sorry. But they still wouldn't pay. Think about that for a moment. Try to imagine how these clowns live with themselves.

So I filed an appeal. A few weeks later, I got in contact with a company in New Jersey that represents screwed claimants like me. I decided to let them file an appeal on my behalf, so I told CIGNA to cancel my appeal and I would resubmit it. They said ok. They even sent me a letter stating the appeal had been cancelled. A new appeal, prepared by this company in New Jersey, was submitted.

To condense this story even further, on FOUR separate occasions over the next nine months, CIGNA told me my appeal had been approved, and on these FOUR occasions when the hospital never got paid and I called CIGNA back, CIGNA told me that information was a "clerical error" and the appeal had NOT been approved. FOUR TIMES. FOUR FUCKING TIMES.

This story has a great ending - hang with me.

After eight months, my resubmitted appeal was denied. Terribly sorry, said CIGNA, but it seems the surgery itself wasn't necessary, so we are considering demanding back the money we paid your surgeon, too. He may bill you. The approval for surgery (not the facility approval, but the actual procedure approval) was - wait for it! - a "clerical error." That's another $5000 or so I'm now on the hook for. In fact, I interpreted this message as a threat, an attempt to intimidate me from pursuing the hospital charges.

I was despondent. I gave up.

One month later, I get another letter from CIGNA. I couldn't imagine what it was for - my appeal had been denied. Game over. I lose.

The letter says, we are happy to tell you that the appeal you filed on July 3 has been approved and payment will be made to your facility provider. Wha?!

Turns out my first appeal - the one I cancelled, the one for which cancellation was verified in a letter CIGNA sent me - was never actually cancelled. So two appeals were in the system. The second one was reviewed first and rejected. The first one was reviewed second, and even though it contained essentially the same set of facts, it was approved.

Terribly sorry. Clerical error. The bill's yours, CIGNA.

See a pattern here?

The moral of the story is, NEVER EVER USE CIGNA."