When the Alaska governor vetoed a bill aimed to expand access to children’s health care, State Senator Bettye Davis wrote an article showing all the services that are not available in the emergency department – including well child care, dental care, physical therapy and neonatal care. Her article is insightful and she raises the very pertinent question – how do people without insurance access health care services? I think she needs to expand her question to include many people with Medicaid. How do many Medicaid patients have access to routine health care?
New Jersey man gets beaten by several teenagers, suffers severe head trauma. Brought to emergency department, admitted, and dies 3 days later. Now a hospital nurse is charged with stealing the patient’s money. If the nurse really did it, he’s a low life, but did anyone check to see if the teenagers may have robbed the patient?
Not the way to get medical treatment more quickly … patient sets fire to his ED stretcher with lighter. First he gets transferred to another facility for treatment of his burns, then gets transferred to the Greybar Motel for rehab.
In other news, as a result of this incident, JCAHO has now outlawed fire.
Speaking about JCAHO, they’re now telling patients that they better “speak up” about falls. Are they branching out into the home safety business, too? Do things like keeping lights on in your house all the time. Put non-slip decals on steps so you can catch your foot and trip over them. Avoid getting old so you won’t lose your balance. If you’re in the hospital, make sure you use the call bell every time you want to get out of bed – don’t do that and your fall is your own fault. If you’re at home and you don’t have a call bell … looks like you’re out of luck.
Better watch it or they’ll decredential you as a patient.
We don’t care if you are an emergency department – we’re not stopping. Ambulance service refuses to bring patients to newly-established free standing emergency department because it isn’t attached to a hospital.
Hospital guarantees fast and comprehensive care. Using the “pick any two” theorem, what do you think the cost will be?
With these “see a physician in 5 minutes or less guarantees” – does the public realize what they often involve? I haven’t worked at a hospital with such a guarantee, but one of my friends formerly worked in one (before leaving due to issues that the whole department was having with hospital administration). She told me that they were required to “pop their head in the room” as soon as any patient showed up and say “Glad to meet you. I’m Dr. QuickSee. I’ll be with you as soon as I can.” There. You’ve officially seen a physician. If Dr. QuickSee can’t make it there within five minutes, the patient gets two free discount movie tickets. Other people have different experiences?
Medical devices injure more than 70,000 kids each year. Common problems included puncture wounds from hypodermic needles breaking off in the skin while injecting medicine or illegal drugs; infections in young children with ear tubes; and skin tears from pelvic devices used during gynecological exams in teen girls. You’ll never guess what the most frequent offending medical device is. Hint: Kids frequently put it in their mouth before using it – something that thoroughly grosses me out.
That videotaping patients thing I keep talking about … it’s coming. The report may be biased because the information is coming from the CEO of a company that manufactures such video cameras, but allegedly some insurance companies are considering whether to refuse malpractice coverage for certain high-risk surgical procedures unless doctors videotape the procedure. Alternatively, surgeons who document their surgeries on video may get lower insurance premiums. I found one article in which the Rhode Island Health Department required a hospital to audio and video record all surgeries for one year after several wrong site surgeries occurred. Also see this discussion over at Kevin’s blog about whether surgeons would be willing to operate under these “Big Brotheresque” conditions.
If malpractice insurance companies won’t cover certain high-risk surgical procedures, guess how many physicians will perform these high-risk procedures. All of you that said “none” – pat yourself on the backs. For all of you that think – “I’ll just go to the emergency department and they’ll have to do the procedure,” think again. If the surgical procedures aren’t emergencies, you’ll get sent home with a list of surgeons to contact. If the surgeries are emergencies and the surgeons don’t want to perform those types of procedures, they’ll just drop their hospital privileges for performing those procedures. Like a lot of neurosurgeons drop privileges for performing brain surgery because of increased liability. Then you get to enjoy the ever-increasing waits to get transferred to a hospital that does perform the procedure you need.
I got your package for ya. Man gets vacation in detention center after yelling obscenities at emergency department staff, then partially disrobing and “performing a lewd act“. I can only imagine what that involved.
The article about the ambulances bypassing the freestanding ER to go to a hospital attached ER was interesting.
It sounds like other EMS services use the freestanding ER.
But the one that won’t is the one that is owned and controlled by the hospital. Surprise Surprise Surprise.
Our local hospital has limited capabilities. Our paramedics will occasionally take patients directly to the bigger hospital 20 miles away. But that decision is based on what is wrong with the patient and how stable they are.
True freestanding ERs (those unaffiliated with a hospital) don’t really want ambulance patients anyway. The drawbacks far outweigh the limited benefits. More patients, yeah. But…
1) Ambulance patients are more likely to be uninsured or (even worse) covered by Medicare or Medicaid than our typical patients. No thanks.
2) Ambulance patients are also more likely to have weaker social support – so if they aren’t admitted, they often don’t have a ride home. Great.
3) And if they are admitted (transferred), then they get two ambulance bills. So they are mad at us and the ambulance service who brought them to us.
We’re perfectly happy taking care of our ambulatory emergency patients. You can have all the ambulances.
Scalpel? Wow, blast from the past. How’s your urgent care going?
Wait, a video record to solve the problem of wrong-site surgery? Um, I’m pretty sure if you replaced the wrong knee or took out my gall bladder by accident, I won’t need a video record to prove that.
How do poor people access dental care, eyeglasses, physical therapy, etc. for their kids? They do without other things to be able to take their kids to a primary physician or dentist. Sometimes it meant that I made hamburger helper with a half- or quarter-pound of hamburger rather than the whole pound the recipe calls for or added additional water to the soup or stew to make it stretch for an extra day or two. It meant sometimes that I would skip lunch entirely or just get a small bowl of a vegetable at lunch in the hospital cafeteria. I was willing to go without food myself to make sure my kids had food and dental care or their immunizations. I bought their clothes at garage sales or at a consignment shop — kids usually outgrow their clothes before they’re worn out, so used clothing can be a bargain. Sometimes I sent the payment for the electric bill to the gas company and vice versa to buy a little time until my next paycheck. Sure, the utility companies thought I was a ditz, but they didn’t shut off my service! Poor people usually find a way — and I never had medicaid! Or food-stamps or any state or federal help. And ex-husbands rarely pay child support on time or in its entirety…
buuuut… what about people who are already doing those things, and still can’t afford to take their kid to the dentist or get him new glasses?
I think Don miscontrues the reason the hospital ambulance bypasses the freestanding ED. If the ambulance is owned and operated by the hospital then the patient is deemed to have “arrived at the hospital” at pick-up and to take him or her anywhere else without a Medical Screening Exam would be an EMTALA violation. Government “help” in action.
Ron Hellstern
“If malpractice insurance companies won’t cover certain high-risk surgical procedures, guess how many physicians will perform these high-risk procedures. All of you that said “none” – pat yourself on the backs.”
Only someone with limited experience in the free market believes this.