WhiteCoat

The Patient Who Lived at McDonalds

Yup. 7151 W. Main Street, Apartment 1 is not a residence. There’s not even an apartment there. It’s a McDonalds.

A patient came in with a “hard lump” on his stomach which ended up being an abscess with quite a bit of surrounding cellulitis. The doc did an incision and drainage on the abscess and started the patient on Bactrim, suspecting that the infection was MRSA.

We got the report back while I was working and the doc was right. It was MRSA. But the MRSA was resistant to Bactrim and the patient needed to be started on a different antibiotic to treat the cellulitis.

We called the phone number the patient gave us. Disconnected.
We looked up the patient’s address to see if there was an alternate phone. As a matter of fact, there was … Welcome to McDonalds, may I take your order?

Hey, bud. You may have waltzed out without paying for your treatment, but have fun with your McSepsis and your McSkinGraft – or maybe even your McCasket.

What goes around comes around.

94 Responses to “The Patient Who Lived at McDonalds”

  1. Ella says:

    Oh, man. Frustrating. He’ll probably show up again soon…

    • Fyrdoc says:

      …with a lawyer in tow who will insist that, even the severity of the infection, your facility should have verified the address and phone number prior to the patient leaving so this wouldn’t have happened…

      • igloodoc says:

        The Docs around here have a saying… Beware of the no-pay that pays you. The process server is next.
        Spin the wheel of malpractice fortune again, Vanna!

      • SeaSpray says:

        Some patients do give false numbers/addresses.

        Most people present with ID or they genuinely left it behind..but do get the info. And then there are those ..that they don’t have *anything* on them ..no id of any kind/no insurance and they will follow up with a call and give it.

        But then there are some (no id/no ins) ..that you just get this vibe … but you still go with what they give you because you can’t challenge them.

        The only verification is for pre-existing medical rec info (especially the phone number)..to update with current information. And to verify if questions, while gathering new information.

        But it’s not the protocol to verify information given during registration. Not feasible. We take them at their word.

        If they lie ..then it’s on them ..I would think.

      • Matt says:

        At what point does reality intrude upon your thinking Fyr?

      • Matt says:

        “Spin the wheel of malpractice fortune again, Vanna!”

        I like that phrase. Those malpractice victims are WINNERS!! Lucky them!! They get to pay doctors lots of money because they have a devastating medical injury!!

      • Fyrdoc says:

        It’s a joke Matt. I realize in the hell you occupy, humor doesn’t exist, but for those of us in EM, we joke, it is what we do!

      • Matt says:

        I guess in the “hell I occupy”, jokes are funny. That’s why I didn’t recognize it as a joke.

      • Fyrdoc says:

        Matt,

        The victims are not the lottery winners, the lawyers are. Can you explain to me how winning a multimillion dollar case somehow means that each hour of your time is suddenly worth exponentially more?

        I’ll tell you what, I’ll keep the current malpractice system as it sits if everytime a patient for whom I provide critical care (as defined by CMS) walks out of the hospital without deficit, I get a million dollars.

      • Fyrdoc says:

        I’m sorry, I assume the devil didn’t allow jokes. As you are a direct employee of his, I just assumed…

        Sorry about that!

      • Matt says:

        “The victims are not the lottery winners, the lawyers are. Can you explain to me how winning a multimillion dollar case somehow means that each hour of your time is suddenly worth exponentially more”

        Again, you’re opining on subjects you don’t understand. It’s like me saying you get paid too much.

        Perhaps you’ve never played the lottery, so you don’t understand. In the lottery, you pay a small amount, do nothing else, and if you’re lucky, through no other effort of your own, you win money.

        If that’s what you think funding a lawsuit against a well funded insurance company is similar, well, you’re more foolish than I thought – if that’s possible.

      • igloodoc says:

        Matt
        It is said that the humor is rooted in the truth, so I am not surprised you didn’t get it. Next time I’ll type a little slower.

        OK.. that was uncalled for … I’m sorry. I plead no contest.

      • Matt says:

        Maybe if it had been even vaguely true it might have been funny.

        Alas, we’ve just ruled out comedy as a field for you physicians when you all leave due to pay cuts.

      • igloodoc says:

        And Matt.. please spell my name right on the lawsuit.

        Damn… sorry again Matt. I plead not guilty, but I want the venue moved.

      • igloodoc says:

        And Matt… better name in the lawsuit the guy who did you radical sense-of-humor-ectomy.

        Ok.. Matt I’m really sorry. I will try to stop now. I’m going to comedy rehab. Probably won’t see you there.

        Sorry again.

      • Matt says:

        I guess what passes for humor among physicians just doesn’t translate out of the clinic. But I applaud your willingness to try! Effort is at least 50% of being funny.

        Maybe watching Anchorman a few times will help. It can’t hurt.

      • Sheckey Green says:

        This comment is out of sequence due to the singular reply link, but…
        Matt…I’ve known some DAMN funny doctors with great senses of humor – who also happened to be excellent medicos…a pain management anesthesiologist and a couple of dermatologists come to mind…I realize you were just returning fire, but I thought I’d mention it.

  2. Sarah says:

    Serves him right.

  3. Paula says:

    A little harsh for a doctor isn’t it? Maybe he was homeless and didn’t want you reporting it so the government could start bugging him with their “help” Too bad you had to make fun of him here on your site. That is why doctors have such bad reputations

    • WhiteCoat says:

      Yeah. Lets give him a McBusticket to your house so he can steal YOUR stuff.
      Then we can work on a Constitutional amendment so homeless people can break all the laws in our nation because we feel sorry for them.
      Get a clue.

      • BOB says:

        Homeless people don’t give an address ….. not smart enough, or too intoxicated, or too mentally ill. This dude likely has an Iphone with a 3G plan, cable TV, spends 5$ on cigs daily yet won’t pay a cent for his medical care. Maybe the bill and culture result should be sent to Paula

      • When you called did they ask you if you wanted the Mcsepsis supersized?

      • CrankyLitProf says:

        They already send the bill to Paula, Bob — as well as to you, me, SeaSpray, Fyr…

    • Katherine says:

      I initially thought that he was homeless, but then realised that what Whitecoat was trying to say was that the guy just didn’t want to pay.

      I like how other replies equate a homeless person stealing someone’s personal stuff with a homeless person getting medical care though. I can really see how much you people care about people in need and universal healthcare.

      Stupid US with their stupid medical policies.

      • Ed says:

        that is because it is very much like someone stealing from me. I pay into the system, they don’t, haven’t, and likely never will. I have to purchase my own insurance and still pay for theirs.

        So, yeah, it is very much like someone is stealing from me.

  4. kateri says:

    That has to be so frustrating. :(

  5. SeaSpray says:

    Hi WC – Your “McSepsis, McSkinGraft and your McCasket… all clever ..but McDreamy and McSteamy and McVet ..much better thoughts. ;)

    I’m a confessed Grey’s Anatomy groupie and so ..I’m just sayin. :)

  6. Big Bob says:

    “A little harsh for a doctor isn’t it? Maybe he was homeless and didn’t want you reporting it so the government could start bugging him with their “help” Too bad you had to make fun of him here on your site. That is why doctors have such bad reputations”

    Paula,

    This patient obviously gave a false adress so he would not have to pay and the doctor, who should be providing medical care to sick patients as doctors are meant to do, now has to worry and try to find this patient – and somehow this makes the doctor the bad guy? What has the world come to. The government is bad for trying to help homeless and the doctor is bad because he gets upset when patients lie to him. God grief. What is this opposite day?

    • Katherine says:

      Ever experienced the help your government gives the homeless? I haven’t either (my government is much more helpful I suspect), but maybe Paula has some experience with the system. Can’t you get arrested for being homeless in the US? That strikes me as really helpful, not.

      • Aaron says:

        I depends on the locality and your particular homeless lifestyle. Many things in the US can’t be particularly generalized nation wide…

      • Big Bob says:

        I have indeed worked extensively with homeless populations and while others may disagree, I have generally found the aid provided by the government to be non-judgemental and compassionate (there just isn’t enough of it). And no there are no laws that get you arrested just for being homeless, but the homeless will sometimes be arrested for loitering, trespassing, etc.

  7. Matt says:

    Yeah, you guys are pretty charming. I can see why you think you’re going to win the battle for the hearts of Americans.

    • VA Hopeful says:

      Sarcasm not withstanding, I think this is all the result of the situation. In medicine, our patients will lie to us all the time for a variety of reasons. I think we all feel a sense of frustration given how powerless we are over the situation. We can’t force patients to tell us the truth no matter what the consequences might be. In this case, had the patient been truthful then the hospital could’ve gotten in touch and said “Hey, you’re sicker than we thought, you need to come back and get treated again.” Obviously no one here wants anything terrible to happen to the guy; however, a harsh lesson might keep this patient from doing this again.

      • Katherine says:

        Or he might die thanks to the stupid US health system (which I in no way blame anyone on this blog for) forcing patients to lie just so they can get medical treatment that they need but can’t afford.

      • VA Hopeful says:

        You don’t have any idea how medicine works, do you? The ED cannot turn anyone away regardless of their ability to pay. This guy got care and didn’t pay for it, he didn’t have to lie about his address.

    • WhiteCoat says:

      When the decision on how to proceed with a multi trillion dollar health care plan comes down to an issue of who is more charming rather than what is in the best interests of the patients … we as a society have already lost.

      • Matt says:

        Like all things political, it comes down to money and ability to sway others. You know this, and your profession does it all the time. Stop acting like such a princess.

  8. hashmd says:

    WC was NOT making fun of the patient. He was using humor to point out a sad situation we see in Urgent Care and ER all the time.

    WC and I are reasonbly certain that the patient was giggling while filling out his registration form putting down the address of the local McDonalds. “Ha Ha I know this is a false address so I get out of being billed for the care”.

    Well, the joke is on him now. He probably will develop necrotizing fasciitis and we did all we could reasonably do to contact him for a change in antibiotic and at least a phone re-assessment of how he is doing.

    And we would be put on the stand in front of “peers” like Paula and have to defend every step that we did, at the expense of hundreds of thousands of dollars, and still possibly lose the case!

    That is why we laugh. If we didn’t, we’d be like the doctor who committed suicide after losing their case.

    • Katherine says:

      Yes I’m sure Paula really means that you should be sued/kicked out of the profession for a little (extra harsh) humour. Obviously us plebs don’t know that you see this type of thing every day unless you tell us. Frankly I feel more sorry for the people that can’t get the care they need than the doctors giving it, though it is really out of hand over there if you can be sued for someone giving you a fake address <_<

    • Matt says:

      Paula,

      No physician can point to a single case resulting from someone giving the wrong address for followup.

      • Ed says:

        And therefore, it never happened.

      • Matt says:

        Maybe it did. Let’s all make expensive decisions on fear of something that we have no evidence has ever happened. I also sell asteroid shelters, so feel free to contact me if you’re interested.

      • Ed says:

        No need. By your logic, if you cannot demonstrate that it has already happened, then it never can.

      • Matt says:

        Your understanding of my logic is shaky, at best.

      • BOB says:

        Matt doesn’t know anything.

        I am on the risk management board for a large ED physician group. We were routinely making about 1-2 payouts a year for the culture follow up issue. Yes, some of them were do to bogus addresses and phone numbers. Knock on wood, we have not had any claims in two years by simply having a policy of not doing cultures on discharged patients. In some cases that is bad medicine but it seems good policy for reducing lawsuits.

      • Matt says:

        Like I said, love to see the case cites. I never mind a little education if you can show me the docs.

      • Fyrdoc says:

        Matt,

        Here you go: In Ray v Wagner (1970) 286 Minn 354, 176 NW2d 101, 49 ALR3d 497, the contributory negligence of the patient appears to have prevented the imposition of liability on a physician who had failed to inform her that a pap smear test indicated the possibility of cancer of the cervix. In affirming a jury verdict in favor of the physician, the court noted that the jury seemed to have found decisive the issue of contributory negligence, although rendering only a general verdict in favor of the physician. It appears that the physician, upon becoming aware of the test results, had attempted several times to inform the patient, but had been unable to contact her due to the misleading information given by the patient as to her address and phone number. The court concluded that it could not say as a matter of law that the evidence did not support a finding of contributory negligence, and accordingly affirmed the order based upon the jury verdict.

        So, if I am reading this, and the decision itself, correctly the appellate court found that the question of the contributory negligence of the patient in providing false information (address, telephone #, etc) to the physician is a decision for the jury. So, the jury could have, just as easily, found in favor of the plaintiff…

        But no matter, I believe the challenge was “No physician can point to a single case resulting from someone giving the wrong address for followup.” Oops. Matt gets schooled again by a legally ignorant doctor with 30 seconds on his hands and access to “google scholar”.

      • WhiteCoat says:

        *crickets*

      • Matt says:

        WC, are you really giving me the “crickets”? You don’t even answer straightforward one line questions. Does your hypocrisy know any bounds?

        But hey, I don’t mind being proven wrong. One should never run from a little education.

        Although I’d like to read the case, which doesn’t appear to be free online. Forgive me if I don’t trust Fyr’s summary of it.

        However, we can say that there MAY exist ONE such case, 40 years ago. And in that case, apparently the jury ruled in favor of the doctor, and was upheld on appeal. Thus, the system has failed?!?!?! We need damage caps because the doctor won?!?!?

        Even if we assume Fyr’s summary is correct, what are we supposed to take from this? That juries get it right and we can trust them to handle malpractice issues?

      • Matt says:

        Here’s the cite to the actual opinion. We now have found 1 case in 40 years. That the jury decided correctly. Pass the caps, boys, they’re badly needed!

        http://scholar.google.com/scholar_case?case=8900883510305459731&q=%22Ray+v+Wagner%22&hl=en&as_sdt=1002

        If you click on “how cited” you’ll find other cases where this one has been cited for some proposition. The facts are not similar though.

        One of the similar cases closed with this statement:

        “The layman would have no conception of the complex nature of the problem. In this case the obvious was correct and the doctor’s diagnosis was wrong. But, recovery is not permitted merely because a doctor makes a wrong diagnosis. If the examination was thorough and competent, and no negligence is shown, the patient cannot recover. The record here discloses an honest mistake in the doctor’s judgment, but does not show he was negligent in arriving at his opinion.”

        That’s an Iowa case, so apparently physicians in Iowa who think otherwise are laboring under a misconception. Should provide you Iowa physicians some relief, and reduce the defensive medicine, eh?

      • Matt says:

        And before someone asks why am I talking about caps? Again, because it’s where all this anti-lawsuit stuff leads. The proof is in the legislation:

        http://republicans.waysandmeans.house.gov/UploadedFiles/Commonsense_Healthcare_Reform_and__Affordability_Act.pdf
        (bottom of page 4)

      • Fyrdoc says:

        Hey Matt,

        The “40 year old case” as you describe it is the basis for the principle in malpractice cases that the level of contributory negligence is a matter for the jury to decide. Thus, the cases you describe (where a suit results from a false address being given) have a legal theory on which to be based (and thus are filed). I didn’t find it on Google Scholar, I asked one one my medical students who is also a JD. He cited it from memory and seemed to indicate any lawyer with much experience in med mal should know it because of it’s import to the principle of contributory negligence. But as you said “I never mind a little education if you can show me the docs”, I’m happy to be of service. (I do understand that med mal is not your primary area of expertise).

        Second, as you have previously pointed out, only appellate level cases are widely available online. So many cases are filed and decided for every case that goes forward for appeal. These appellate cases are used to put forward the theories on which cases are based, correct? To quote the Ray v. Wagner decision (available here: http://scholar.google.com/scholar_case?case=8900883510305459731&q=%22Ray+v+Wagner%22&hl=en&as_sdt=400002) “While it seems clear that defendant had a duty to take whatever steps were reasonable to notify plaintiff of the results of the test she took in August, it was for the jury to decide whether the failure to reach plaintiff was the result of negligence on the part of the doctor, and, if so, whether such negligence proximately caused the condition which resulted from her ultimate treatment. Because of the general verdict, it cannot be determined which issue the jury found decisive. However, the request for further instructions on contributory negligence seems to have prompted the trial court to state that this issue was decided against plaintiff. We might well have come to a different conclusion as jurors.” This seems to indicate the court believes this type of claim may have merit and should proceed to a jury – in fact stating “We might well have come to a different conclusion as jurors.” But from this we are supposed to believe no claims like this are ever filed or decided against the physician? When the court all but said they disagreed with the jury’s decision but upheld their right to make that decision…

        Lastly, any time you disprove any portion of any post, you gloat shamelessly and accuse everyone else of “lying”. So sir, when you state “No physician can point to a single case resulting from someone giving the wrong address for followup.” – you are lying.

      • Fyrdoc says:

        Matt,

        Now do us a favor would you. Since you always gripe that physicians do things that have no hope of reducing our liability, how should we, in your opinion, reduce our exposure to these contributory negligence cases?

      • Matt says:

        “He cited it from memory and seemed to indicate any lawyer with much experience in med mal should know it because of it’s import to the principle of contributory negligence.”

        Given that the case would not be controlling in other states but the one it came from, I doubt it would be familiar to many lawyers who were not practicing there.

        “But as you said “I never mind a little education if you can show me the docs”, I’m happy to be of service. ”

        And I sincerely thank you for it.

        “. So many cases are filed and decided for every case that goes forward for appeal. These appellate cases are used to put forward the theories on which cases are based, correct? ”

        No, it’s not a choice at the state court level like the Supreme Court. State appellate courts hear whatever is brought before them. The appellate decisions consider the trial court’s judge and determine if the law was correctly applied to the facts.

        “But from this we are supposed to believe no claims like this are ever filed or decided against the physician? When the court all but said they disagreed with the jury’s decision but upheld their right to make that decision…”

        I don’t think they did say the jury was wrong. Appellate courts typically defer to the fact finder. And I don’t think you should believe claims like this aren’t ever filed. Clearly they are, and I was incorrect.

        ” Since you always gripe that physicians do things that have no hope of reducing our liability, how should we, in your opinion, reduce our exposure to these contributory negligence cases?”

        You misstated my “gripe”. My statement was that you claim to do all these things “defensively”, and you say we should get rid of juries because you have to act defensively. But you have no idea if your defense works. So why should we change the law, typically to allow caps on legit cases, when there’s no evidence 1) that what you’re doing makes sense, and 2) that you do less of it when you get the reform you ask for. Given that you apparently misunderstood what I said, perhaps that will clear it up.

        As to the rest of your question, do you mean the filing or the exposure to your insurer possibly paying via settlement or judgment?

      • Matt says:

        “Lastly, any time you disprove any portion of any post, you gloat shamelessly and accuse everyone else of “lying”.”

        You have a tendency to make up things about what I post, or maybe just misstate them. But if you feel the tone of my posts are “gloating”, I’ll be glad to be more polite. Of course, I’ll expect the same from you.

        If I wrongly accused you of lying, my apologies.

        And again, I freely admit I was wrong. But it is nice to see you for once acknowledge (however vaguely) that every once in awhile I do “disprove” one of your claims. I’ve never seen that from you or WC for that matter. WC usually just doesn’t reply and moves on.

        If both sides would be more willing to acknowledge a mistake, perhaps we would have a more constructive dialogue. Although at the end of the day, all our dialogue doesn’t really change the fact that caps are the centerpiece of tort “reform” and that single payer will likely make it all moot. We’d have to spend some money to change that, and jabbering on the Internet is so much cheaper!

  9. ladyk73 says:

    In my experience with the mentally ill… They are pretty straight-up with their homeless status. They may even give you cross street and compass direction for their most common hang out (or sleeping area)

  10. Lisa K. says:

    If the patient ever comes back, will you give us an update on the story? I, at least, would like know what happens.

    • WhiteCoat says:

      Haven’t heard anything from/about him in a few weeks, so don’t expect that he’ll return for follow up. If he does, I’ll post an update.

  11. Sarah G says:

    I worked for about 7 years at the Reports Desk in my local police department. ‘General Delivery’ was the address homeless people got. No, we did not arrest them.

    A large portion of the homeless I met (and I met a lot of them on 3rd shift) would have been uninclined or incapable of memorizing the address to a local McDonald’s. Come to think of it, most people don’t memorize that stuff anyway. Any chance he worked there?

    • WhiteCoat says:

      Good point. I didn’t get the impression that the patient was homeless – I think the whole “homeless” issue was raised in one of the comments.
      I suspect that the patient used a false name, also.
      Hospitals generally don’t pursue patients like this, so I doubt that patient accounts will follow up on it and doubt that the police will ever be involved.

  12. NurseBeth says:

    Matt:
    Our hospital got sued for just that. A pt gave false info, we were unable to contact them about a positive culture report. Pt came back in a week later in full blown sepsis and died. ER and hospital got full responsibility-appears we should have “sent the sheriff out” to look for said person, gone door to door, whatever! Now the DOH says we have to look outside and down the street for those LWOBS pts that left after a 2-3 hour wait for sniffles. It happens, it’s true. It stinks.

    • Matt says:

      Got a case cite? I only ask because medical providers are chock full of apocryphal stories that never seem to be borne out by the actual facts of the case.

      • DensityDuck says:

        I’d think a LAWYER would know better than to suggest that a healthcare provider flagrantly violate the HIPAA.

      • Matt says:

        Only a physician would think it’s a HIPAA violation to give the name of a case that’s public record.

      • DensityDuck says:

        Why do you think I’m a physician?

    • A. J. Campbell says:

      I defended a very similar case a few years ago, though it was not an attempt to avoid paying, at least not primarily. A drug dealer came to my hospital client’s ER and gave a fake name, an address where he did not live and someone else’s phone number. The wet read of his CXR was negative, but the radiologist’s over-read the following day was “questionable infiltrates,” so staff tried to get him back in for follow-up. Unsurprisingly, multiple phone calls and a telegram to the address were unsuccessful in reaching him. Two weeks later, he presented to a different hospital with a raging antibiotic-resistant pneumonia which ultimately killed him. My hospital was sued and spent over $100,000 defending itself before the case was settled, mostly by the second hospital.

      Way to move the goalposts, Matt. First you said no doctor could point to a single case resulting from a patient giving a “wrong” address and that there is no evidence that this has ever happened. When an appellate case was cited, you said it didn’t count because defendants won (who cares what they spent to prepare, try and appeal the case) and anyway it was a long time ago. When other commenters then described litigation in their experience arising from false information given by patients, you refuse to believe their accounts because their stories are “apochryphal” (euphemism for lies). My case did not result in an appellate decision, so it does not appear in any official reporter. Even if I gave you the name and case number, the county court where the case was filed did not put its dockets on line until after our case concluded, so you’d have difficulty confirming it. Thus you will no doubt feel justified in dismissing me as another of those apochryph-ers who tell you things you don’t want to hear. But the fact that you dislike and disparage the evidence doesn’t prove that “there is no evidence this has ever happened.”

      • WhiteCoat says:

        “Moving the goalposts”
        Classic.
        That one’s going into my repertoire.

      • Matt says:

        “Way to move the goalposts, Matt”

        Perhaps you didn’t read closely. I didn’t move the goalposts at all. I certainly didn’t say it didn’t “count” nor was it something I “didn’t want to hear”. I asked for the info and I thanked him for the cite and noted we now have one. It appears we may be up to 10 cases.

        I don’t think that’s an excellent reason for caps, though. Which is the point of all these “horror” stories, anyway. We may all agree that some cases shouldn’t be filed. In fact I’m sure we do. I just don’t know why capping the damages of cases where the jury DID find malpractice is the solution.

        “you said it didn’t count because defendants won (who cares what they spent to prepare, try and appeal the case) and anyway it was a long time ago. ”

        Actually, the DEFENDANTS didn’t spend that money. Their insurer, who insures just this type of risk, spent that money. But I most certainly did not say it did not count. I said the system worked in that it took a claim, considered the evidence and reached a decision I presume you believe is correct. Again, no system will preemptively stop claims BEFORE they are filed. If you think so, you’ve watched Minority Report too much.

        You should read what I actually wrote. It’s much more interesting than what you think I wrote.

      • A. J. Campbell says:

        Well, Matt, considering that we’ve generated maybe ten cases just from WhiteCoat’s readership, an infinitesimal percentage of the population (sorry, WhiteCoat), I’m waiting to read your comment that says, “I was completely wrong when I said ‘No physician can point to a single case resulting from a patient giving a wrong address’ and ‘There’s no evidence this has ever happened.'”

      • Matt says:

        AJ, I’m not sure what kind of self flagellation you’re looking for, but I don’t think I have any more to offer you. I quite succintly stated I was wrong and thanked Fyr for the information.

        The thing is, even if you’d found 1000 in the last 40 years, or 1000 per year for the last 40 years, when you consider that by WhiteCoat’s estimation there are a billion physician-patient interactions each year, you’re still talking an “infinitesimal” number of claims percentage wise.

        Again, read what I wrote, not what you think I wrote.

      • A. J. Campbell says:

        Matt, I was mistaken in saying that you had not acknowledged your error; I didn’t re-read the entire thread and didn’t observe that you and Fyr had re-opened your exchange above after I posted my first comment down here.

        Your comment to the effect that Defendants don’t pay for their defense is no more accurate than your initial generalization about no cases like this existing. The hospital in the case I described was self-insured; there was no insurance policy or insurance company writing the checks. Even when my client is an individual doctor, there is a modest chance he’s hitting the hip personally. Over the past 25 years, I’ve always had some uninsured docs in my active caseload, constituting 5-30% of my docket at any given time.

        The money for defense doesn’t rain down like manna from Heaven, even when there’s an insurance company paying the bills. It still has to come from somewhere, and one of the main places it comes from is the doctors’ premiums. I agree with your oft-repeated point that, when indemnity payouts and defense costs drop, premiums don’t drop by the nearly the same percentage, but that doesn’t mean that being sued imposes no cost on Defendants.

      • Matt says:

        “Matt, I was mistaken in saying that you had not acknowledged your error.”

        No worries, we all make mistakes.

        “The hospital in the case I described was self-insured; there was no insurance policy or insurance company writing the checks.”

        So the hospital determined it makes more money investing or otherwise utilizing premium dollars it would be given to a third party. At the end of the day, the hospital has put itself in the risk business. I’m not sure why I should feel sorry for them? Do they offer to pay the attorneys fees and costs of people who they make file suit instead of promptly paying on legit claims? Of course not. Where is the outrage over that?

        “Over the past 25 years, I’ve always had some uninsured docs in my active caseload, constituting 5-30% of my docket at any given time.”

        Likewise with an uninsured person. Do we chastise them if they can’t pay a judgment on a legit case? If you make a financial choice not to purchase insurance, I have no problem with that. But you’ve put yourself in the risk business, then. You are taking the risk that you’ll pay certain fees out of pocket even in a case you win, and the public who deals with you is taking the risk you will be able to cover your damages. You guys want to cry about what the uninsured doctor pays on cases he wins, but what about when he justifiably loses and can’t pay the injured party?

        “It still has to come from somewhere, and one of the main places it comes from is the doctors’ premiums.”

        Actually, most property and casualty insurance is written at a loss when you consider premium income v. admin costs and payouts. The money is made on the float. That’s what affects premiums.

  13. Painless says:

    I honestly have to say how I love the fact that you gave care… and FREE CARE at that to this person and everyone is condemning you about it. Katherine, I have never seen a homeless person arrested for being homeless – quite a few of them DON’T want help from the government – they are happy with what they have and how they live their life. And yes, they will tell you what street they live on, cross streets, etc. although they usually give the name of the shelter they use. I have cared for many of them in my career and have even given free care at the shelter.
    What this guy did was purposefully give the wrong information to avoid being billed. Period. It’s called stealing. Period. I have yet to see anyone in 20+ years of medicine, including pre hospital, ED or ICU be uncaring towards patients. Again PERIOD. They may joke around about it, they may not like the system, but they are in this profession to help people. I am sure there are a few who are in it for the glory or the money – just like I’m sure there are a few lawyers who are out there to help people and not worry about making a buck. I have yet to meet one however.
    For those of you who come on here to be critical of what we do, those who make all manner of unkind remark – WHY ARE YOU HERE? Is it just to upset us so you can get your jollies? So that you can prove yourself to be a better person or to prove you are more intelligent? If you don’t like what’s posted, if you don’t want to share constructive idea’s or just want to antagonize or criticize at every turn… why not just leave? I know I’ve had my fun with a couple of these people. But after a while it gets old to hear the same old “I’m smarter than you, I know what’s going on and you don’t” comments. Please, get over yourselves and move on.

    • Matt says:

      He didn’t give “free care”. He contracted to provide care to get the government money. Physicians act like they GIVE away at no benefit to them. That’s not true. They sign a contract with the government to get government money. As part of that deal the government says hey, you take them as they come.

      Your profession cut this deal with the government decades ago, and each of you reinforce it every time you sign on for more.

      If you’re going to whine anytime someone criticizes you, then you need to do a couple of things. One, stop criticizing everyone else, like you just did in the post above. On the second, you need to avoid all media.

      Whether you like it or not, your profession is part of a debate that is raging across America. It affects a lot of people, and some of them are going to have different opinions than you. And *gasp* they may be right and you may be wrong. And many of those who disagree with you are doing it because they feel like they are helping people, even if you disagree.

      Now, there are a few physicians who are humble and open to the possibility they may be wrong and aren’t out just to put a few more dollars in their pocket. I have yet to meet one however.

      If that kind of criticism bothers you, perhaps you shouldn’t be tossing it at others, and perhaps you shouldn’t be so condescending to people you don’t know. And you should probably consider that your ideas aren’t the only constructive ones, and just because someone disagrees with you doesn’t mean they reached their opinions just because it’s in their own self interest, rather than the public good.

      In short, treat others as you would like to be treated.

      • DensityDuck says:

        “They sign a contract with the government to get government money.”

        What the F*** are you TALKING about? Hospitals get government money because they CLOSE if they don’t get it. Patients like the mope described above are the reason why they need it.

      • Fyrdoc says:

        CMS, through certificates of need, have made it impossible to practice emergency medicine in this country without accepting MC/MA. Thus EMTALA applies. To suggest this is optional is simply wrong.

        Matt, this would be the same as the government stating that any criminal defense attorney who pleads any case in any state or federal criminal court must accept whatever fee their client wants to pay them. Saying “well it is optional to plead cases in criminal court” wouldn’t work as I assume to BE a criminal defense attorney, one must plead cases in criminal court.

      • Matt says:

        “What the F*** are you TALKING about? Hospitals get government money because they CLOSE if they don’t get it”

        Thanks for making my point. You’re right, your profession has put yourself in a point of weakness, but at the end of the day, it’s the choices YOU make that put you there. And for that matter your predecessors.

      • Carter says:

        Mr. McFakeaddress has nothing to do with any type of government contract. Don’t know what Matt’s retarded point is there.

        I will agree with Matt in a general sense though. The train is off the tracks. Physicians lost their power and influence as soon as a third party came between the patient and physician in the 1950’s and even more so when the the gubment created Medicare in the 1965. Todays physicians had nothing to do with it unless you are a practicing physician above 70 years old and lobbied for this kind of thing. Some brainwashed fools will stand behind Obama in whitecoats and lobby for mare of the retardedness. Now the beast has grown, government engineering created an entitlement society and the Medicare Ponzi scheme is in its end run. Physicians have no say in the current debate.

  14. Dave says:

    I currently am salaried, but spent enough time in private practice that I feel I can comment here. Our group, as every other group, was on “service call” on a rotating basis. We were assigned the care of any indigent person or patient without their own physician, who had to be admitted while we were on this call. Every physician in the community did this, and to my knowlege all these patients received the same level of care as our private patients, even though I cannot remember being paid by a single one of them. There was no contract I made with the government to give this service and I wasn’t happy about having to drag myself to the hospital in the middle of the night to take care of someone who I knew wouldn’t pay me, but we considered it as our collective duty to give this service, and indeed there was no other mechanism for managing these people. Most (not all) physicians in my community also saw medicaid patients, again because these people needed care and most doctors in the community felt it was a shared responsibility to perform this service. One physician calculated that the reimbursement he recieved for seeing them was $5.00 less than his overhead, so this made poor business sense. This happens daily in this country. It’s one of the reasons medicine is a profession and more than just a business, although there are enormous social forces trying to change this.
    I will interject here that many of my medicaid patients did not fit the usual stereotype, and were just people who were with limited resources and were poor. A number of my medicaid patients had Down’s syndrome, and were an absolute joy to care for – I always got a hug, they were incredibly appreciative. They were all employed in some little “job” and if I told them they had to stay home for a few days from “work” they’d break down in tears, in contrast to “normal” patients who would often push for as many days off as they could get. Personally I think we can learn a lot from these gentle, loving souls, but I digress.

    The point I’m making is that statements like “There may be a doctor (or choose whatever profession you want) who is not in it for the money but I’ve never met one” are just plain ignorant, even in the heated venue of blogs. All doctors expect to make a good living, but have to watch the economics of this business to keep an office going, pay staff and overhead, etc. But the fact is that most people, including doctors (and nurses, janitors, executives, auto mechanics, and even lawyers) try to do as good a job as they can regardless of how much they make monetarily at that particular task. It is also true that a lot of physicians continue to see medicaid patients and medicare patients despite it being very poor business sense, but they feel a sense of duty to these patients. If you want some insight on this problem google “Mayo clinic and medicare patients”. Mayo lost a ton of money on medicare patients last year and is now limiting them – a business decision, that I bet a lot of docs at Mayo disagree with.
    The issue with the emergency room, I think, is partly that none of it is voluntary. If you are an ER physician you are mandated by law to see anyone, but the law does not mandate that you be reimbursed, despite the fact that you incur cost and liability to see them. The emergency medicine group may be contracted by the hospital but may still make their living on their billings. The patient Whitecoat talked about basically stiffed them for the bill and caused them a lot of trouble trying to track him down, and he’s rankled about it. This is his forum to ventilate. I can’t believe the flak he’s getting for this post.
    Sorry for being longwinded.

  15. Matt says:

    “The point I’m making is that statements like “There may be a doctor (or choose whatever profession you want) who is not in it for the money but I’ve never met one” are just plain ignorant, even in the heated venue of blogs”

    I agree. I think they’re ignorant when you’re referring to about any profession. Professions are not the best way to make a lot of money, after all. You’re better off to sell something or become an investment banker. That’s why the comment was tongue in cheek.

    • Big Bob says:

      Matt,

      You have on multiple occasions stated (without irony or humor) that there is not a single doctor who is concerned about anything other than money, which pains me greatly having experienced the trememndous sacrifice that many doctors make.

      • Matt says:

        I have actually never said that without sarcasm. Try again. I have in fact clearly stated that accusing someone of being money hungry is irrelevant to the point of the quality of one’s proposals.

        Most of the “they’re greedy” stuff comes from physicians towards others.

      • little BOB says:

        Most of the “they’re greedy” stuff comes from physicians towards others.

        ……and matt says he is not a troll. The internets are a wonderful thing….you can just sit around all day and say stupid stuff

      • Matt says:

        I’m guessing you don’t read much. If you did, you’d find many, many posts about how “trial lawyers” are “just in it for the money” and how they oppose tort reform just because “they’re greedy”.

        But your post did prove your last sentence, so you got that going for you. Which is nice.

  16. McSepsis and McCasket? I’m still LOL…awesome post.

  17. Ed says:

    How many lawyers take a client with no regard as to whether or not they can pay?

    Every lawyer I have had the misfortune to deal with wanted not only a substantial amount of money up front, but then charged me for every bit of minutia that occurred.

    • Matt says:

      Lawyers who are paid by the government do. Lawyers who, just like physicians, agreed to take the government money in exchange for agreeing to take all those who qualify for representation on the government’s terms.

      Look, if you told attorneys that general practice lawyers would get an average salary of $150,000, and specialists would get an average of $250,000, like physicians and surgeons do per year, you’d probably have a lot of lawyers sign up to take all comers at that rate. And those are average salaries across the nation. There are much higher averages in urban areas.

      Physicians cut this deal with the government and the third party payors. They may not like it now, and if they don’t they should head out into the free market. But one thing to remember about the free market – your pay doesn’t always go up. It doesn’t even always stay the same.

      • DensityDuck says:

        What’s the typical cost for dealing with a legal malpractice suit?

        What’s the typical rate of legal malpractice suits, per legal provider per year?

        Are lawyers required by law to provide free legal advice to whatever extent needed to anyone who walks in the door?

      • Matt says:

        1. Don’t know – don’t do that type of work and haven’t had a claim made against my policy (knock on wood). I imagine the insurer contracts with the attorneys at some rate, and the cost depends on the complexity of the claim, but I don’t know what the average rate is.

        2. Don’t know that, never asked. I don’t know that there are any real studies of that, since legal malpractice insurers haven’t mounted PR campaigns for damage caps or other protections, there hasn’t been a need. If you find one, though, that would be interesting to know.

        3. Not unless they’ve contracted in some way to do so. For example, if you’re an insurance defense lawyer, you may have contracted to take whatever cases they send you at a certain hourly or flat fee rate. If you’re a government lawyer, like a public defender, you may be required to handle whatever cases the agency employing you asks regardless of the ability to pay.

        4. There is no professional that’s required by law under all circumstances to give away their services. That may be part of an agreement they have with a payor, though, where they take all comers in exchange for receiving money from the payor.

      • Ed says:

        1. How many doctors work in a field, other than teaching, that does not require them to hold malpractice insurance?

        2. No study? No case? Never happens then.

        3. You still have to pay for a public defender.

      • Matt says:

        1. I have no idea.

        2. Legal malpractice suits never happen? That doesn’t make much sense.

        3. By you, do you mean all taxpayers? You pay a nominal fee at best, but you’re constitutionally guaranteed representation at no cost if you cannot afford an attorney on a felony matter. Don’t know why you think otherwise.

      • Ed says:

        Because I know an individual who was appointed council and, following their case, was billed for said council.

Leave a Reply


eight − = 4

Popular Authors

  • Greg Henry
  • Rick Bukata
  • Mark Plaster
  • Kevin Klauer
  • Jesse Pines
  • David Newman
  • Rich Levitan
  • Ghazala Sharieff
  • Nicholas Genes
  • Jeannette Wolfe
  • William Sullivan
  • Michael Silverman

Subscribe to EPM