Wednesday, September 26, 2007

Daughter, Yours

She'd been a party-girl all of her life and looked twenty years older than her stated age of forty-one. The last time she came to visit us she had been down for a while outside during the very hot summer months and had developed a nasty rhabdomyolysis.

Her CPK levels were in the one-hundred-thousands, or about a thousand-or-two times higher than normal. Multiple injection sites, urine drug screen positive for cocaine, dehydration, and general abuse of the body were all in play.

This slammed all hell out of her kidneys and she ended up on dialysis for a few weeks. The case managers had gotten her set up with our state Medicaid system so we'd get paid a little bit of money to cover a fraction of the cost of the care she needed.

She was discharged with an intact permacath and hemodialysis scheduled for three times a week.

She never followed up with dialysis, she never took her medications, and she never stopped partying... until a couple weeks went by and she was shivering with fever and came back to the hospital with an infected permacath, sepsis, and really crappy lab values.

The indwelling hemodialysis catheter was immediately removed and antibiotic therapy initiated. The workup revealed a blood clot in the aorta, too. A big sucker, that one, but on follow-up trans-esophageal echocardiograms it didn't appear to be moving around.

Oh lucky day.

Medicaid coverage has to be re-upped every six months and hers needed doing, but they had lost their copy of her birth certificate which she had presented on her last go-around. She was basically homeless and in no condition to go scouting about the town to find it, so the case managers were stuck and unable to establish insurance for her.

This meant that the local skilled-nursing facilities, which would typically provide the weeks of long-term intravenous antibiotic therapy she needed; well, none of them would accept her as a patient without any ability to pay.

So we had to keep her and provide the care at the hospital. Just staying in a telemetry-monitored hospital bed likely costs over a thousand dollars a day, plus the antibiotics, blood transfusions, routine medications, labwork, supplies, food services, linens, and all that jazz. Like my pay. Beaucoups bucks.

Nobody says beaucoup around here. Mucho dinero, maybe, but she wasn't of Mexican heritage.

The hospital will have to absorb the six-figure cost of her stay. I can hear the howls from the compassionate conservatives. She's a poster-girl. But really. This is somebody's daughter.

And this is the best healthcare system in the world. I'm not in this gig for the money but if they don't pay me, I cannot afford to be a nurse. No nurses means no hospitals, and you will be driving to Mexico for your own healthcare.

1 comment:

Dirk Gently said...

This is also a fine example of this truism: the more different systems of medical payment there are, the fewer choices in medical care. If there were only one payer, and if medical costs were paid based on needed procedures given rather than who the patient is, that patient could go to the place most capable of handling the problem instead of the place most willing to accept her plan (or lack of one).

The waste and redundancy and stupidity of a for-profit free-market health care system propped up by patchwork government programs and overstressed charities is maddening.