Gotta love Texas.

[theweaselking]

Women spends 19 hours in Emergency room of hospital without being seen by a doctor, is charged $162.

Bonus: Because she *can't* get medical care, she's using a hillbilly splint for her fractured leg and HOPING it's going to heal correctly.

Extra bonus: Same hospital, a few days earlier, another man showed up with chest pain, waited 19 hours, and then died of cardiac arrest. Without being seen by doctors.

Super mega bonus: The commenters are all doom and gloom about how thankful they are that they don't have socialised medicine, because, you know, more funding for hospitals in total, much lower cost per patient, and people having the ability to see a doctor for preventative care rather than waiting and needing emergency care are all BAD things. Really.

Comments

[http://users.livejournal.com/_jeremiad/]

She got assessed by a nurse and then chose to go home. That's what she got billed for.

Emergency rooms are really bad places. Emergent cases take priority over non-emergent ones...like fractures.

The bit about the guy dying from the heart attack is excruciatingly sad though.

[theweaselking.livejournal.com]

She was not seen by a doctor, she did not have her complaint addressed, and she was not provided with any treatment or medical diagnosis. She owes nothing, because they did nothing.

She waited 3.5 hours for a triage nurse to show up, ask her what the problem was, then go back to ignoring her for the next 15.

Unless you want to have her pay, and then sue the nurse for practicing medicine without a license and the hospital for letting her do it. I'd be okay with that, really.

PS: fractures are emergent, and cannot be treated outside a hospital. They're just not *usually* life-threatening.

[http://users.livejournal.com/_jeremiad/]

She had her vitals taken by a medical professional. The machines cost money. Nurses cost money. You're not just paying for the services of the doctor when you go the hospital.

I doubt the triage nurse was ignoring her. Have you ever been to an emergency room? To an emergency room in a really large city? One that handles trauma? They're madhouses. The people who are dying take priority (as they should) over the people who are not.

Registered nurses are licensed to practice medicine by the way. That's the 'registered' part of the whole thing. What they can't do is prescribe medicines or provide diagnoses, unless they are nurse practitioners under a doctor.

Fair enough. Fractures are emergent. But they're less emergent than gunshot wounds, stab wounds, car accidents, heart attacks, etc. etc. And they can be treated outside a hospital, in say, a clinic.

I'm not saying it's okay that she didn't get treated. I'm really sorry she didn't get her leg set. But acting like the doctors and nurses in the emergency room were just sitting on their asses and ignoring patients isn't the right impression either.

[jerril]

But acting like the doctors and nurses in the emergency room were just sitting on their asses and ignoring patients isn't the right impression either.

You need to reread everything Weaselking wrote.
He's not acting like they were sitting on their asses.
He's not suggesting that.
He's not stating that.
He's not implying that.

He's offended she had to pay despite not receiving treatment. Yes, the nurses salary has to be payed, but a couple of points:
1) I see no reason why the patient should be paying for being triaged by a nurse, and not being treated by anyone. If I go talk to a lawyers office, talk to the secretary, and get told the lawyer isn't taking any new customers (or is on vacation, or is otherwise occupied right now), the law firm does not send me a bill for $162 for the secretary's time. An RN is qualified to give treatment, but a) I'm not sure that includes bone setting, and b) that is a strawman as THIS RN did NOT give any treatment in this case.
2) There's no equipment use involved in this case. There's no way she got an x-ray AND a nurses time AND a radiologists time all for $162 in the USA. So that's no excuse.

She got no services.

Triage of a broken bone largely consists of

• double checking to make sure the suspected break isn't anywhere potentially dangerous (torso, neck, head, thighs, you get the idea),
  
• isn't compound (and therefore potentially dangerous wherever it is),
  
• and confirming the pt doesn't have any other potentially dangerous complaints from whatever broke the bone ("oh, by the way, I also hit my head when I fell and now I'm seeing double").

I've been in ERs regularly for various bits of trauma that were suspected sprains or breaks to my limbs. Triage for simple breaks and sprains is not treatment.

[http://users.livejournal.com/_jeremiad/]

Actually, I did read everything he wrote, especially the part where he said the nurses were ignoring the woman with the fracture which implies that they weren't doing anything else.

It costs money to get your vitals taken. You are paying for the medical professional's skills as well as for the cost of the equipment. Gettings your vitals taken is a part of treatment as the attending physician needs to know if, say, your blood presssure before administering treatment. Furthermore, nurses only act under the direction of the attending physician which means the nurse took the patient's vitals at the physician's orders. That's all a part of treatment. Acting like vitals is somehow unimportant doesn't help your case at all.

Furthermore, the comparison between a secretary and a lawyer isn't the same. Secretaries aren't licensed professionals for one thing. Nor do they have to attend several years of highly intensive and structured schooling in order to be secretaries. I'm unaware of any bachelors of secretaries degrees or masters of secretaries of degrees or Ph.D.'s in secretarying. Comparing nursing to being a secretary demeans the profession, and that's what nursing is, a medical profession.

I'm not sure how long it's been since you've been to an emergency room, but taking vitals does require equipment. I'm also not sure if you read the article as it clearly states that the got the X-ray taken at a chiropractic school, and not at the hospital.

The services she got were having her vitals read by a trained medical professional. That is a medical service, and it was done at the direction of a physician. And you're wrong about triage by the way...it's the beginning phase of treatment. Assessing a patient's severity and taking their vitals are a part of treatment.

If we want to talk about familiarity with the system, my Dad is an ER physician. My Mom is a nurse. I was recently in the ER for a serious medical emergency.

She sounds like she's pissed for not being seen when she wanted to be.

[unknownpoltroon.livejournal.com]

This is a great idea. I'm gonna open up a restaurant, take orders and never give anyone food!! I can still charge them cause the order was taken by a trained foodservice professional!!

Once I get some money for that, I'm gonna open up a auto garage, and have a trained automotive professional tell people they need a new engine, never do it, and then charge them anyway!!

[theweaselking.livejournal.com]

And if they complain, you can say they just didn't wait long enough!

[http://users.livejournal.com/_jeremiad/]

So, you're saying she should not pay for services rendered (which, for the record, were having her vitals taken by a nurse)?

That'll set a great precedent, yeah.

[unknownpoltroon.livejournal.com]

She went there to get her leg fixed. They did not fix her leg. If she was objecting to the 200 bucks as a part of the bill for getting her leg fixed, I would agree with you. If you want to get paid, you have to perform the service that is needed.

[http://users.livejournal.com/_jeremiad/]

Because working in the food service industry or in an automobile repairshop is exactly like working in an Emergency Room.

Who knew?

[unknownpoltroon.livejournal.com]

No. Because charging someone for not performing a service is the same anywhere.

[fengi.livejournal.com]

Well, see you're appealing to rational argument here and ignoring the true point which is judging someone for not paying a bill.

[http://users.livejournal.com/_jeremiad/]

I'm judging her for having a flawed reason for not paying the bill.

She's not saying she can't afford to pay. She's saying she doesn't want to pay.

Not the same.

[gryphart.livejournal.com]

Whether or not the doctors and nurses are working their tails off (and I suspect they were) if they had 19 hours straight of problems more severe than a fracture, there's clearly something broken with the system. The hospital clearly needs more staff, needs to redirect patients who aren't near-death elsewhere, or in some other way needs to improve its services to provide useful care.

[http://users.livejournal.com/_jeremiad/]

This I absolutely agree with, but a broken system isn't the staff's fault. That's an administrative problem.

[gryphart.livejournal.com]

I think most of the problems in medicine are usually administrative/financial/governmental, and often out of the hands of the practitioners (much to their frustration.) It's why I'm sincerely hoping for some reform in our system soon; both the caregivers and the patients in the present one all too frequently get screwed.

[kadath.livejournal.com]

sue the nurse for practicing medicine without a license and the hospital for letting her do it.

Dude what? Nurses are licensed to practice medicine, what with being medical professionals and all.

fractures are emergent, and cannot be treated outside a hospital. They're just not *usually* life-threatening.

Fractures are not necessarily emergent, nor do they necessarily require hospital treatment. A fracture that threatens arteries or nerves is emergent. The way to know is to go through triage.

The article does not contain enough information for me to confidently armchair-diagnose the type of fracture the woman sustained, but the fact that it "seems to be healing" suggests a minor stress fracture ("hairline") a common sports injury which is neither emergent nor life-threatening.

I am not disagreeing with your thesis that the American medical process is FUCKED, but your facts are wrong in this case and you're making pronouncements that are outside your area of knowledge.

[unclebebby.livejournal.com]

Parkland is one of the busiest hospitals in the DFW area, and from what I've heard, they normally only keep about a single doctor on staff at the ER, two during the busy time.

Ironically, this is the same hospital that Kennedy was brought to when he was assassinated.

[drjon.livejournal.com]

We have "socialised" medicine here in Oz.

It can be a bit of a pain sometimes.

It don't blow goats like Texas, though.

[fearmeforiampink]

There are issues with it, but it means that when I'm ill I go to the doctors, and I don't worry "But how will I pay for it".

Also, a lot of percieved problems with it come from the fact that it's at the size where diseconomies of scale are being felt, and thus while it provides efficient, and generally high level of healthcare, it's very hard to improve it further, and costs a lot to do so.

[drjon.livejournal.com]

Whilst I'm by no means an expert, it seems to me that there's been too much political meddling. The level of healthcare is excellent, but accessing that healthcare can be problematic. More beds, more Doctors, less meddling. I'm in Qld, we just had a new Children's Unit inappropriately place for political reasons.

[fearmeforiampink]

That is part of the problem certainly – I was discussing a little while ago the idea of making the leadership of the NHS in some way partially independent of the government, in a similar way to that which was done to the Bank of England.

The Bank of England has had the decisions about changing interest rates, and I believe certain other functions, devolved to it – Parliament needs to approve it within 28 days, and the government could just change the rules back to set interest where they want it, but in theory the Bank of England's monetary committee picks the rate of interest.

The idea behind this was that playing with the interest rate was too tempting for government ministers, generally resulting in short term political gains at the cost of medium to long term finanacial instability. Thus, taking the power out of their hands improved financial stability.

It'd be much harder to do similar for the NHS, but the reasons behind it would be the same – the government's priority is making it look like they're doing a good job, the NHS's priority is doing a good job.

HOWEVER, the political interferance isn't the only cause of the problems. As an organisation gets bigger, it becomes much harder to monitor it. WHen it's a dozen people, the person in charge knows them all, can see how they're doing, and can say "Chin up and at them", or "Get your act together" as neccessary.

In something the size of the NHS, that's obviously not possible. Individual managers of groups can do that, but those higher up the chain need some way to check on those managers and their groups, and make sure that they're working (i.e. that the manager is doing their job).

This is where targets come in. The problem with targets is that they promote actions that make you meet the targets, rather than actions that deal with the issues that the targets are there to promote dealing with. Governments make this worse by setting targets that look good to the public, but actually cause more problems, but the neccessity and effects of setting targets is its own problem.

[goblinpaladin.livejournal.com]

It's a lot less socialised than I'd like, frankly. But I watch stories about the US and wonder how people can stand to live there.

[degeneratelyre.livejournal.com]

I hate this nonsense. I detest bringing in a patient that I know needs medical help and quickly, only to come back hours later and find them lying on cots in the Fishbowl or the Dance Hall because the rest of the ER is too busy to get around to them as quickly as they should. Some hospitals do charge for triage assessment, but waiting 3 hours just to be triaged is ridiculous. And waiting very nearly 24 full hours for help? Insane.

*grumble*

[runewise.livejournal.com]

One more reason I'm glad I'm Canadian.