Three hours in the ER

michaelalreadytakenApril 27, 2007

$9466.03: that's what the bill comes to for a tad less than three hours in the ER.

Insurance paid $7099.55 and the balance has been automatically "waived." How generous!!!

(Please note that the radiologist's bill hasn't shown up yet--I think we all know how that works.)

It really doesn't matter who the patient is, does it?

For this all inclusive price, our winner received:

1) Basic blood work-- that he didn't need.

2) A portable CXR-- which he did need.

3) An IV of normal saline-- yes, necessary.

4) Routine telemetry monitoring and some O2-- necessary.

5) Nothing else, no CT Scan, no MRI-- nothing else.

No neurochecks were done. One of the few times in medicine when it's actually necessary to shine that silly little penlight into someone's eyes-- and it doesn't get done-- for ten thousand dollars. Actually, I'm not being quite honest. At discharge I kindly asked the nurse if she'd "mind" checking his pupils-- like she'd have a clue of what to look for anyway.

I used the term "neurochecks" when I spoke to her and she looked like she'd been tasered. I hate to ask but it's just that since he fell down and largely destroyed a wall in the process that maybe--if it's not too much trouble--you could make sure he isn't hemorrhaging.

No nurse saw the patient for a one and one-half hour period while I sat at the bedside and watched them pass by.

No one noticed two "episodes" of bradycardia into the forties-- and other associated activity which occurred during that time. The alarms were off. But I noticed.

In short, no one did anything. Unless, unless, one considers being greeted at discharge by the ever so good looking and over friendly, unctuous, patronizing, and happily condescending ER doctor who blithely reassured me that everything's fine.

My own personal thoughts during that session, unspoken, went to something along the lines of:

you have three seconds to take your nitwit paws off of each of my respective shoulders before I take them off for you-- the same neurologic activity that precipitated this little excursion has now occurred twice in your ER and none of you even knows it-- and no--everything isn't "fine."

In the end, I smiled and said nothing. Silence and a smile in the face of incompetence and ignorance is my latest defense mechanism.

Is it be too overwrought, too much of an exaggeration, to just go ahead and call it ten thousand dollars?

In any other setting-- it'd be called "fraud" to take that kind of money from someone--people would be labeled as felons and sent to prison and have their rights as a citizen permanently revoked-- but not American healthcare.

Two thoughts:

1) Thank God for insurance.

2) This can't possibly last


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farmgirl(9 NoCA)

I may be fortunate that one trip to the ER at Kaiser cost me nothing. I was in desperate need of pain relief from a then undiagnosed nerve disorder involving my entire right leg. Considering I slipped on their wet floor, launched my crutches across the ER waiting room and landed in a heap against a wall, perhaps they thought a "freebie" was appropriate. The conversation went something like this:

Are you ok?
I don't know.

Are you visiting someone or are you here to see a dr.?
Here to see a dr. Why else would I be in the ER?

Is anything hurt? (I guess the crutches weren't enough of a hint?)
My foot; it may be broken.

It took two nurses to hoist me off the floor as I could not bear any weight on my swollen purple foot. They loaded me into a wheelchair and promptly parked me in the middle of the waiting area. I was ushered into the Intake area in record time...15 min. The next conversation was more irritating than the last:

Are you the one who crashed in the ER parking lot?
Yes, but it was the lobby. I slipped on your wet floor. I think you should do a work-up to make sure I haven't broken any bones. Your "wet floor" sign was 15 ft away from the door, it's raining outside and your floor mats are soaking wet.

Ok...but I need to ask some questions: age, weight, health status, marital status, etc. Then the female history portion: meds, pregnancies, are you pregnant now?
Dude, I just told you I'm 52. Pregnant is not an option. I've been on estrogen for some time.

Ok...when was your last period?
Not for a long time.

I need to know...a year...two years?
Does 1986 work for you?

By this time, this idiot's irritation factor has overridden the pain in my leg. My daughter saw my fingers start to twitch and moved my wheelchair back, just in case I lost my last shred of patience and reached for his throat.

So off I go to X-ray. Nothing broken. I got to see a dr. who had no idea why my foot had all the indications of being broken but wasn't. He decided I needed a cast anyway and that I should see an orthopedist in Fracture Care the next day.

The ortho dude asked why I was there if nothing was broken. I told him his guess was as good as the last dr's. Off comes the cast. Nothing was mentioned about my version of the Fosbury Flop in the ER.

Just one of many wonderful moments courtesy of Kaiser Permanente's medical system.


    Bookmark   April 28, 2007 at 12:05AM
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Having spent many wonderful visits to the Oakland Kaiser ER (for acute migraines), I can tell you, Carol... be glad, very glad, that you've got Kaiser. Because what happens if you don't have Kaiser is what happened to Michael.

I've had some truly awful visits to the Kaiser ER but most have been merely unpleasant. Whereas with non-Kaiser hospitals, I've had one absolutely wonderful experience (in the midwest, in a university town during the summer), and many hellacious ones.

You do remind me of a time way back when I was in college and had what turned out to be some anonymous tonsillitis (since had the silly things excavated). I had quite a high fever, and waa given a shot of penicillin in the rump while standing behind a curtain in a treatment room. I stood up, zipped up my jeans, stepped out from behind the curtain, and fainted dead away on the floor as several waiting patients sat around and watched from just a few feet away.

Two nurses descended on me. "Are you all right, dear?" (I fling myself on linoleum floors on purpose, for fun.)

Michael, I can't believe you didn't have a rage-induced stroke.

    Bookmark   April 28, 2007 at 2:54AM
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LOL at flinging yourself on the floors!! I am with ya'll, I KNOW those people are busy, overworked, underpaid, etc., but those really aren't excuses to be so slack. Hope everybody's everythings are feeling better.

    Bookmark   April 28, 2007 at 8:03AM
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rozannadanna(8 TX)

Tiger all I can say is "Dear God, they are still living?? You know it it had been me someone might have ceased doing that.

    Bookmark   April 28, 2007 at 8:58AM
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carla17(Z7 NC)

I'm restraining myself on comments to health care, cost, doctors, state of the country...
I will say if this person is alive, he is lucky.


    Bookmark   April 28, 2007 at 10:13AM
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anntn6b(z6b TN)

We have had a veterinarian, now in semi-retirement, who is an excellent diagnostician. He can look at a patient and ask questions of the companion and do a few palpatations and then prescibe medicine or other treatment that makes the patient better.
It's a shame that my ILs' Dr.s don't have a tenth of his skills. But then, that would require they look at their patients for more than a minute.

    Bookmark   April 28, 2007 at 12:20PM
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jannorcal(No CA z9)

10 K for that!?1 I can't believe that all that was done were labs and a CXR. Amazing. Guess telemetry monitoring in the ED is pricey. The nursing care does not surprise me. EDs are very busy and the RNs do just the basics.

What might be more interesting is to get a hold of the dictation from the MD. Might be quite revealing.
When I had an ED visit for a kidney stone the doc documented all kinds of PE findings that he did not assess
(eg full H&N exam including JVD).
I spoke to and sent the docs physician supervisor a letter telling him about the fraud.
Doubt anything changed though.

    Bookmark   April 28, 2007 at 1:33PM
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EDD got frequent flyer miles after all the heart attacks and the angioplasties. My favorite er trip was walking across the street from a doctors office to ER 3days after Edd had been discharged from cardio care. "he possible having a heart attack" Just sit and wait we'll get to you the doctor was supposed to call ahead just sit and wait and we'll get to you...yeah well if you look in your computer you'll see he was just discharged from cardio care nad before she could say it again. "Sweetheart he will lay on the floor and grab his chest and scream and gasp we already agreed to this remedy before we got here will that work.. well if looks could kill I'd be dead but they can't so I'm not afraid of looks from doctors, nurses, landlords or lawyers...(cops are another story) He was having another episode I love that word for (we haven't a clue).

    Bookmark   April 28, 2007 at 10:54PM
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Jo, sounds like acute coronary syndrome-- or not. Regardless, I love your plan of action.


I'm wondering about the totals too as I think more about it and may just ask for a review.

Rozanna, yes kitten, they're still alive. LOL. I wasn't kidding about the silence and the smile as a defense mechanism. I just wanted him out of there. The only reason I/we ever--rarely--call an ambulance is if the respiratory function doesn't fully return in quick order-- and that's why we called them this time-- plus a hard hit to the head.

For the record, it was neither of the big "two" providers up here..

As difficult as this all is, all's well that ends well-- once again.

Far more difficult is that he's had to withdraw--again--from school. He had a 4.0 but this episode wiped him out for three days and then he had another one the next week and that wiped him out for three more days, etc. and there's no keeping up under those circumstances in tough classes.

On a brighter note--and to my total surprise--on his last regular visit to the specialist--surgery was recommended. It had been ruled out as an alternative in New Orleans. I didn't bring it up as an option, his doctor did, and he seems to think it's an excellent option whereas the MD in New Orleans said it wasn't one at all.

None of the records from New Orleans have been forthcoming after Katrina--so maybe that's a blessing--or not--I don't know.

So, second and third opinions are being sought--and I'm keeping expectations very low.

We'll see.


    Bookmark   April 28, 2007 at 11:48PM
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farmgirl(9 NoCA)

I think my bad-mouthing of Kaiser care was bad karma for me. I've been a mail carrier for 17 years and never had a dog bite incident. Today, my neighbor's 130 lb. Shepard mix was over for a visit with my daughter's dog. I was watering the plants. I knew that Titus liked to play in water so I was spraying him. He was snapping at the water and managed to bite my thumb. He opened a 1/2-inch gash just below the knuckle and the another 3/4-inch gash on the inside (hand side?). Both bled quite freely and with fairly intense pain. Did I go to the ER? No. Despite being unable to stop the bleeding with pressure and ice for over 20 min., I decided a couple of butterflies and a tight wrap with tape would do the trick. It worked, although it took my neighbor and daughter to hold things together and apply the tapes. I did not want to cause trouble for my neighbor or the dog. Nor did I want to sit in the ER for a couple of hours to get a couple of stitches or a glue-job and a band-aid. The only thing I can't do for myself is get antibiotics, although I have plenty of Neosporin smeared over the butterflies. If my home remedy isn't enough, I will have to eat crow and do penance in the ER tomorrow. Are sack cloth and ashes appropriate attire for a situation like this?


    Bookmark   April 29, 2007 at 1:42AM
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MAT, apparently everyone else knows the story about your -- son? partner? -- and now I'm curious... I was assuming this was a parent, but someone who's in school? Youch.

Carol -- LOL. If you cleaned it out pretty well you may escape without needing AB. Just be glad it wasn't a 130 lb. cat. Now that's a scary idea.

I had one of my really acute migraines today, as it happens, and was MISSING Oakland Kaiser. Kaiser is much more provincial up here and getting there and seen as I need to be for these is a huge hassle. So, I just stayed home and puked all day. Carol, you can say hi to them for me when you head over for your antibiotics. :)

    Bookmark   April 29, 2007 at 2:48AM
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farmgirl(9 NoCA)

Don't laugh, but I have a 20 lb. cat. I am grateful that I only got nailed by two teeth instead of an entire mouthful. Titus is a formidable dog. I will be thinking of you should I have to spend a large portion of my day at Kaiser.

    Bookmark   April 29, 2007 at 3:03AM
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meredith_e Z7b, Piedmont of NC, 1000' elevation

Carol, the word on the net is to buy fish-tank antibiotics rather than having to come up with $150 plus med costs for antibiotics. God help us all.

MAT, I am so sorry y'all had to go through that. I swear the sadness I have over how hurtful, dangerous and greedy these things can turn out to be is so immense. 'Course I have a too-late diagnosed nerve disease that I contend with daily as a constant reminder ;] Then Mom, etc... oh I've seen too much. Thank God you are a nurse yourself! You are way ahead of the game then, and those poor folks who don't know a thing [why should they have to?] are the ones I have so much fear for.

I'm so glad he's safe. That's the important thing in the end, and God knows there are way too many folks who don't end up safe at all.

3 personal cases that have made me wary and sad:

#1 A 19 year old on tricyclic antidepressants with no blood serum test bcomplains to the psychologist about racing heart, outrageous blood pressure detected when trying to give blood, dilated pupils, and NIGHTLY HALLUCINATIONS 6 hours after taking the meds. Advised to stay on them by therapist [MS in Social Work]. Psychiatrist [MD] asks about her 'bad dreams.' Corrected by patient. He laughs at her estimate of the racing heartbeat figure. She is advised to stay on the meds. He does no check of BP, heartrate, etc. A month later, she lapses into a coma at her house... the medicine is 6-9 times the normal blood serum level, and could have been fatal at any time.

#2 A Stage 4 breast cancer patient is [miraculously] in remission for 8 years. She tells her gyno about a new lump in the same breast. He says all is fine, no biopsy, nada...come back in 6 months. She gets a second opinion. Yes, it's cancer again.

#3 The nerve/blood disease diagnosis. A difficult diagnosis at first, true. But no care or tests past one CBC for 3+ years, as the patient goes from 128lbs to 89lbs and does not know why, still complaining of ever-worsening symptoms, is unacceptable. When insurance let her see a different doc, he runs a Pernicious Anemia and syphillis rundown the first day after physical examination and interview. She is on b12 shots the day after the results come in, and the progressing nerve damage is halted, too late to reverse a significant amount...

The overwhelming theme seems to be the doctors not wanting to run tests that may have helped, if I understand it all correctly. They were busy, or somehow practiced medicine by psychic intuition that failed them, I suppose. Wish the whole shebang didn't cost so much, at least, if poor psychic abilities had replaced standard medical care and thats OK in this day and age ;(

OOoooh... thanks for the rant and so glad you are educated enough to know what to do when the caregivers fail you. No, this can't continue, can it? :(

    Bookmark   April 29, 2007 at 5:25AM
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farmgirl(9 NoCA)

Dog Bite Update
Tapes came loose; started to bleed late Sat. night. Called Advice line and was told to go to ER for stitches and antibiotics. Went; waited 4 hrs. Came out with no stitches, loosely wrapped gauze bandage, script for Augmentin. Cost: $50 for ER services and $10 for drugs. Had to submit dog bite report. That went to the county animal control.

Animal Control followed up on report. Neighbor went nuts. Told me day of bite dog was current on shots. He lied. Dog hasn't had shots in 5 years. Then he lied to AC officer; said I was teasing the dog. Threatened to burn down the neighborhood if they took the dog. Made several unsavory comments about me. I told him his dog was not worth losing my thumb over. Lose appendage; lose job; lose house. Dog is not worth the risk. Cops were called. A 10-day home quarantine was arranged. Dog must get vaccinated and then they are to appear in court for violations. Meanwhile, I am the bad guy and must wait to see if the dog develops symptoms. I doubt he will, but it looms ahead of me as well as possible tendon damage and infection. I guess that kills a 12-year relationship with my neighbors.


    Bookmark   April 30, 2007 at 10:46PM
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Yes, that is the law, all animal bites must be reported.

I'm sorry for the trouble and hope your hand gets better quickly. They're lucky the dog is "only" on a home quarantine and nothing more.


    Bookmark   April 30, 2007 at 11:00PM
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farmgirl(9 NoCA)

Thaks for the good thoughts. Thumb is healing well; only one small area of drainage. I hope all is well with you and yours.


    Bookmark   May 5, 2007 at 1:19AM
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Carol and Michael - hope ya'll are both feeling better. ER's stink, don't they?

    Bookmark   May 5, 2007 at 7:43AM
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meredith_e Z7b, Piedmont of NC, 1000' elevation

Carol, I hope all feels well, too! I've been both bitten and attacked, and dog bites can be surprisingly painful. Antibiotics are the key thing, I've been told. BTW- I'm getting a tatoo to cover one scar on my arm, lol. Turn it into a fashion statement, eh? :)

MAT, I do hope the patient is doing well and finding the care that he needs. I hope the school is cooperative, too... that can be very hard, but I bet he's a smart, strong scrapper... just a guess ;]

    Bookmark   May 5, 2007 at 10:59AM
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mjsee(Zone 7b, NC)

Oh...I could tell some stories...but it's bedtime. Hope all is well and everyone is healing. I'll try to check in more frequently...I'm back to a full schedule at the Garden Center and it IS spring.

love all of you!


    Bookmark   May 5, 2007 at 10:36PM
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jerseywendy(z6 NJ)

Did someone say ER?

First off, Michael, I hope you're doing much, MUCH better.

Secondly: I'm waiting for 2 ER bills, and I'm bracing myself.
Last month I accidentally swallowed some water of my "curing" saltwater fishtank. It honestly was a mistake - I wasn't thirsty or anthing like that! (I was seen quickly due to my disorientation and the color of my tongue. I had to strip down to my underwear and put on one of those robes. When the (moronic) doctor came in to see me, he didn't even bother to look at my tongue. He asked me: "WHY would you drink saltwater?" I was so dumb-founded, I replied: "Because I was thirsty?"

Of course I tried explaining that it was an accident, and tried handing him the sample water, which we had put into an empty bottle of Vitamin C.

The good doctor took a look at the container and said: "Oh, you won't feel like that from taking Vit. C."

A DUH!!!! Again I told him WHAT was in the container, but he was so preoccupied with God knows what, he said again: "Vitamin C won't discolor your tongue."

Then I've had it. I told him he hadn't even bothered looking at my tongue, so how could he possibly know WHAT my tongue even looked like? My husband had to step in because I was ready to jump off my stretcher into the good doctor's face.

To make a long story short (yeah..right), he sent me home. With NOTHING! He said to go see my family doctor if I got worse. No, they couldn't/wouldn't test the water, there was nothing they could do.

2 days later I was at my family doctor because I was developing a high fever on top of my black tongue and all other symptoms. They tested my blood AND the water. I had consumed some bad bacteria (gees - who would have guessed), and needed to be put on antibiotics QUICKLY. I even got an injection of antibiotics to give it a jumpstart. I was also put on a short term steroids, and within less than a week I was back to normal.

So - considering what went on in the ER, what will they charge us? (I should charge THEM.)

Saturday my oldest son busted his knee open at the beach and went to the ER. They found it necessary to take X-rays before administering 6 stitches. Sigh! So I have a pretty good idea how much we'll be paying.

rant over...sorry everyone

    Bookmark   May 8, 2007 at 7:32PM
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Wendy, uh oh, sounds like the good doctor was operating on wayyyyyy too little sleep.

Why oh why must delicate medical emergencies be handled by people who may not have slept in 36 hours? Surely the first people to realize what serious sleep deprivation can do to one's cognitive abilities and judgment would be a medical professional.

That doctor would have been hearing it from me, probably quite loudly. Ugh.

    Bookmark   May 8, 2007 at 7:52PM
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jerseywendy(z6 NJ)

I completely agree with you nickelsmumz8. IMO it is humanly impossible to "think" normally without sleep after 24 hours. The mind will shut down slowly, and so will the body. I don't care what anybody says, but a person DOES need sleep after so many hours of intense work, especially doctors/interns.

My son spent 4 hours in the ER Saturday, but he said he will never forget what all he "heard" during those 4 hours. He heard accident victims cry and shout, overheard drunks that had been arrested, drug (ab)users moan, etc.

All in all, sure, I see red when I think about MY latest encounter there, but there is always someone who's off worse than me, so I shouldn't even complain.

However, it is NOT right how much these health institutes are charging us.

    Bookmark   May 8, 2007 at 8:14PM
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wild_rose_of_texas(z8b TX)

First I need to say I am so sorry to read everyone's bad experiences in your local ERs. It seems to be a universal problem!

Second, since I haven't been on this forum in a long, long time, and it is easy to make social faux pas when you are an outsider, I ask that you forgive the interloper, please?

After a couple of life altering personal experiences with receiving poor health care, I just have to blurt out this truth: emergency departments are dangerous places to visit. Do so as infrequently as you possibly can.

I have been in an ER three times in my life. Twice I was misdiagnosed. I even argued with the ED physicians on duty in both instances, and provided the rationale for why I believed what I believed. I was scorned. I was ignored. Basic assessments directly relating to the presenting symptoms were not done, even though I pointedly told the physicians and nurse practioner on duty each time what I was concerned about. They did not even bother to argue with me, or offer me any other diagnosis for their focus of assessment. The most recent of these events was finally, recently, settled out of court. I won.

Be very, very careful of the health care you seek, and the care you allow to be rendered. If at all possible, take your camera, your camera phone, and a tape recorder with you to the event. It can make a difference when the attorneys get ahold of it later on. My attorney was gratified that we were so quick thinking.

    Bookmark   May 15, 2007 at 2:45AM
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I recently talked to an ER nurse who said that there are patients who will call 911 from the ER! Well, I was in the ER recently (actually bleeding to death -- still no one seemed very impressed until I'd already lost a lot of blood) and I know the feeling.

    Bookmark   May 15, 2007 at 8:21AM
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