It's unthinkable, but the care you get at hospitals could make you sick.
1. "Emergency? Take a number."
Earlier this year Thelma Gundlach felt her arms go numb and her vision turn fuzzy. She sensed a stroke coming on and had a friend rush her to the emergency room at a hospital near her home in Modesto, Calif. Gundlach, 67, expected to be seen right away. Instead, she waited four hours in an emergency room jammed with other patients. Gundlach survived (her stroke was a minor one), but now says, "It's unnerving to think about going back there."
Lots of other patients feel exactly the same way, Thelma. A 2000 study conducted by the National Center for Health Statistics revealed that patients with nonurgent problems (where life or limb are not at risk) wait an average of 68 minutes to be seen, up 17 minutes from 1997. "Generally, if you come in with a chest pain, you'll get seen quickly," says Robert McNamara, chairman of emergency medicine at Temple University Hospital in Philadelphia. Otherwise, "you'll wait hours — as many as 12, based on what I've seen."
While it's no fun thinking about getting hurt, McNamara suggests you do some planning ahead for an injury or illness. For instance, scout around for an emergency room with a fast-track area that will address minor complaints quickly. "Also, if your emergency is not life or death," he says, "take a few minutes to call and find the hospital with the shortest wait." And avoid getting seriously ill on Mondays between 2:00 and 10:00 p.m. That's often the busiest time for emergency rooms.
2. "We'll misdiagnose you to pad your bill."
Making patients wait in line is one thing. Purposely inflating the level of care required to treat an illness (and jacking up the bill) is downright criminal. Just ask Rick Newbold, a Center Bridge, Pa.-based physician turned high-tech whistle-blower. Newbold employs a self-devised software program to reveal billing inconsistencies. So far he's uncovered more than 100 hospitals he accuses of hyping patient illnesses. He brought his findings to the attention of the U.S. Attorney's office for the Eastern District of Pennsylvania, which to date has helped recoup more than $15 million for Medicare, the usual victim of this particular scam.
But it's not only insurers that suffer from this fraud. Jim Sheehan, an Assistant U.S. Attorney based in Philadelphia, says such shenanigans by hospitals have "a real impact on the public. It increases the expenses people pay, in taxes and in health insurance." Unfortunately, patients and their families often have little indication they're being used in this way.
3. "Our surgeons get confused."
Did you hear the one about the Florida woman admitted to a hospital with a brain hemorrhage? The surgeon operated on the wrong side of her brain. Or how about the Brooklyn hospital where an ophthalmologist mistakenly operated on a patient's good eye?
These O.R. goof-ups would be laughable if they weren't so awful. Euphemistically referred to as "wrong-site surgery," such mishaps have risen from 16 nationwide in 1998 to 58 in 2001. To protect yourself from becoming a victim of a directionless doctor, your first defense is avoiding incompetent hospitals. The Joint Commission on Accreditation of Healthcare Organizations does qualitative studies on health-care facilities across the country and posts its results on its Web site, www.jcaho.org. Second, don't cut your surgeon too much slack. Before you go under anesthesia, discuss with him exactly where — and why — he wants to make incisions. Don't let him make a cut unless you're completely satisfied with his answers.
4. "You're not welcome here."
Hospitals should be egalitarian places. Exclusivity does not belong in the operating room. Everyone deserves the best health care possible.
Sound reasonable? Perhaps, but patient advocates say it's not uncommon for hospitals to delay or deny service if your health-insurance coverage fails to meet its pricing standards. "If you have a major illness — like heart disease or cancer — you want to go to what I call a 'center of excellence,' a place with the best care and most experience at treating your condition," says Ron Pollack, executive director of Families USA in Washington, D.C., an advocacy organization for health-care consumers. "But the first thing a hospital will do is biopsy your wallet in order to figure out how you plan on paying. And if your insurance plan won't pay everything they want, then the hospital will want you to put up the remaining dollars."
Though hospitals are legally obligated to treat patients at risk of life or limb, none are required to treat you after you have stabilized. Longer-term treatment — at the hospital of your choice — with the wrong insurance policy will require a persuasive argument. "Sometimes the insurance policies have appeal rights, so under extraordinary circumstances, you can get yourself treated at a hospital that does not seem immediately (welcoming)," advises Alwyn Cassil, spokeswoman for the Center for Studying Health System Change, in Washington, D.C. "If the physician responsible for facilitating your care says that you can't get appropriate treatment within your existing network, that physician can be a powerful advocate for you. Remember, it's best to know your appeal rights before you need to use them."
5. "We partner with your doctor — to commit crimes."
Physicians are expected to send patients to the hospital that can best treat their conditions. In Kansas City, Mo., though, a pair of brothers, Drs. Ron and Robert LaHue, were found guilty in 1999 of violating the Medicare Antikickback Act. They accepted payments for regularly sending patients to Baptist Medical Center. In addition to the brothers, a hospital official was sentenced to prison time.
Hospitals use more than money to induce doctors to send patients their way. Some require physicians to bring a certain number of patients into the hospital just to remain credentialed with them. "Some hospitals are giving kickbacks rather than the best care," says Sheehan, the Assistant U.S. Attorney. He adds that kickback crimes showcase an even more insidious element: "Your doctor tells you that you need a certain treatment, you trust him, and you go for the treatment. Most patients don't expect the hospital to pay him to make decisions that may not be in their best interest."
6. "Don't trust us to keep your private life private."
Patient records are packed with sensitive information that you'd expect hospitals to keep hush-hush. Tell that to a woman the courts call Jane Doe. Her uterus tore during an abortion at Hope Clinic for Women in Granite City, Ill., in June 2001. She was treated at Saint Elizabeth Medical Center. Days later her snapshot and hospital record appeared on a pro-life Web site. Doe is suing Saint Elizabeth in Illinois state court for failing to protect her medical records. "Somebody gave her hospital records to (pro-lifers)," contends Doe's lawyer Mark Levy. (An attorney for Saint Elizabeth declined to comment on the suit.)
While patients can usually request that information not be shared on internal hospital networks or that a specific person be blocked from accessing reports, hospitals "may or may not agree with your request," says Joy Pritts, senior counsel of the Health Privacy Project at Georgetown University. While in office, President Clinton issued rules that will require hospitals, starting in 2003, to get a patient's written consent before releasing information to insurers, doctors and pharmacists. The Bush administration, however, wants to change the Clinton ruling so that hospitals would not need prior consent.
7. "And you thought you were coming here to get cured."
In the spring of 1998, Jill Cahill was admitted to a Syracuse, N.Y., hospital after being brutally beaten by her husband, James. Six months later he went to the hospital and finished the job (poisoning her with cyanide). Or consider this: In April 2001, at Savannas Hospital in Port St. Lucie, Fla., a patient allegedly beat to death three other patients and a nurse.
Such lowlights highlight the sticky middle many hospitals find themselves in when it comes to security. "Most people like to see hospitals as an open environment," says Tony W. York of Hospital Shared Services, a Denver-based health-care-services firm. "I like to see visible security people walking around on patient floors." He also wants to see both employees and visitors wearing identification badges at all times. Worried that an unwanted guest may pay a visit to your room? York says, "The hospital should be willing to accept" a list of people whom you don't want admitted. How well the hospital enforces it, he adds, is "a whole other issue."
8. "Our skin banks get depleted — just when you need them most."
In 1999 Sadie Nolan underwent a dozen operations at University of Wisconsin Hospital and Clinics (UWHC) in Madison after being severely burned in a car accident. Sadie was in constant danger of not getting the lifesaving skin she needed. Two months later she died. Afterward, her mother, Kate, began to wonder why there was such a shortage of donated skin. She says she was shocked to learn that skin donated to Allograft Resources, the tissue bank affiliated with UWHC, was unavailable. "It had moved on to a for-profit tissue-engineering company," according to Kate. But Allograft President and CEO Nancy Holland says, "We never received a call to help Kate Nolan's daughter."
UWHC spokeswoman Linda Brei acknowledges that the hospital did not have an agreement with Allograft to receive skin tissue donated by its patients. She says, however, that UWHC now uses a different tissue bank and is "contractually given first priority on live skin." Still, there are hospitals without such reciprocal agreements. Plus, Kate Nolan says many patients and their families are misled when they decide to donate skin. She advises donors to "think about where you want your skin to go. Write it out on a donor card. And make sure your family knows."
9. "Need a doc? Don't we all."
America could use a few good surgeons — stat. Largely as a result of rising malpractice insurance costs, a surgeon shortage is affecting certain specialties. According to a spokeswoman for the American College of Obstetricians and Gynecologists, OB/GYNs in such states as Pennsylvania, Nevada, New Jersey, New York, Mississippi and Texas are leaving the profession, fleeing to less litigious states, or cutting back on high-risk procedures, such as obstetrics and gynecological surgery.
"This problem is threatening our health-care system's ability to meet its responsibility," says Ed Thompson of the Mississippi State Department of Health. Currently, Thompson faces a dearth of obstetricians and neurosurgeons, and he has set up a tracking system so that ambulance dispatchers can send drivers to trauma units where neurosurgeons are available — even though the length of such trips may put patients in added danger.
10. "Your new organ has defects."
Most of the time a patient in need of a skin, organ or bone transplant can expect the hospital to provide healthy body parts. Most of the time. But Tom Skinner, spokesman for the Centers for Disease Control and Prevention in Atlanta, warns, "We've been investigating bacterial infections found in people who've undergone reconstructive knee surgery. These infections can be serious. One person has died, and a number have become sick with infections."
While Skinner points out that half the infections can be traced to a company that processes tissue used in reconstructive surgeries, Theodore Malinin, director of the University of Miami Tissue Bank, says that if a hospital has a tissue bank, it "is responsible for collecting" the tissue and it "should know how it has been treated." Malinin suggests you ask your surgeon for "the maximum insurance of safety" where bacteria may come into play. He says he not only conducts about 200 bacterial tests but will also run screens for various transmittable diseases "even though many of them are not required by law."