Medical bills underlie 60 percent of U.S. bankrupts, 75% of bankrupt families had health insurance

[justashooter 430]

I call BS on this bogus agenda driven article. Health care is an underlying factor in bankruptcies in as much as spoon usage is an underlying factor in obesity.

[Peikko 1,575]

All it takes is to change the bankruptcy laws so people can't just bum out of their obligations. You just put them into debt for the rest of their lives and this bankruptcy due to medical bills discussion will go away. Many of the debtors have perfectly good organs they could sell to pay up. That would be a lot better than communist "solutions". There, I said it.

Can I run on a GOP ticket now?

Cleo approves this message.

I don't. Instead of selling their organs (how barbaric!), why not just stop treating people who cannot pay?

Problem solved - no more emergency room freebies.

What are you going to do with all the dead/dying people? I don't want them cluttering up the streets and stinking the place out.

No, much better to make a profit and increase the availability of high quality organs. Win/win.

Wouldn't it depend on what the dying people are dying of and what the dead people died of? Their organs may not be such 'high quality'-just sayin'.

Obviously when the donor can't produce healthy organs himself, he will have to ask a family member to pony up.

[mawilson 2,133]

Obviously when the donor can't produce healthy organs himself, he will have to ask a family member to pony up.

You can't ask people to pony up on an ex post facto basis. What if he has no family members?

What if they have crappy organs too? Once you start treating these bums for free, it's a slippery slope.

Got insurance? No? Then show us your assets / proof of income. Can't? Sorry, can't help you.

[w¡n9Nµ7 §£@¥€r 123]

Got insurance? No? Then show us your assets / proof of income. Can't? Sorry, can't help you.

Agreed. To treat and prolong the lives of people who add no value to society (as measured by their ability to purchase health insurance) is like promoting the growth of a cancer instead of killing it.

[Peikko 1,575]

Got insurance? No? Then show us your assets / proof of income. Can't? Sorry, can't help you.

Agreed. To treat and prolong the lives of people who add no value to society (as measured by their ability to purchase health insurance) is like promoting the growth of a cancer instead of killing it.

This is true. Perhaps they can be treated only if they can prove that they have a nice healthy organ to donate should bills not be paid in a timely fashion? We really do need more organ doners and it just seems so wasteful to allow this potential organ gold mine to escape our clutches.

[w¡n9Nµ7 §£@¥€r 123]

Perhaps they can be treated only if they can prove that they have a nice healthy organ to donate should bills not be paid in a timely fashion?

Good idea!

[mawilson 2,133]

Got insurance? No? Then show us your assets / proof of income. Can't? Sorry, can't help you.

Agreed. To treat and prolong the lives of people who add no value to society (as measured by their ability to purchase health insurance) is like promoting the growth of a cancer instead of killing it.

Can you go to a hospital in India or the Phillipines and get free treatment?

[w¡n9Nµ7 §£@¥€r 123]

Got insurance? No? Then show us your assets / proof of income. Can't? Sorry, can't help you.

Agreed. To treat and prolong the lives of people who add no value to society (as measured by their ability to purchase health insurance) is like promoting the growth of a cancer instead of killing it.

Can you go to a hospital in India or the Phillipines and get free treatment?

In India, you could get free admission in the state run hospitals but that doesn't mean much. I've seen patients lying in beds in the hallways with stray dogs licking their wounds.

[tmma 467]

Got insurance? No? Then show us your assets / proof of income. Can't? Sorry, can't help you.

Agreed. To treat and prolong the lives of people who add no value to society (as measured by their ability to purchase health insurance) is like promoting the growth of a cancer instead of killing it.

....or being put on a sort of 'priority list' for treatments or specialist appointments...such as who gets the dialysis machine/chemo/radiation/mri first. It's all wrong. Socialized, private...whatever, it's unfair and BOTH ways are centered around money. You pay one way or another-with money on premiums or roulette with your life wondering if you actually are getting the best care available to give you the best chance- wondering if the place you are in is going to cut corners, miss stuff or not test for stuff because it's not in their budget for the quarter.

typos

Edited July 8, 2009 by tmma

[Peikko 1,575]

Got insurance? No? Then show us your assets / proof of income. Can't? Sorry, can't help you.

Agreed. To treat and prolong the lives of people who add no value to society (as measured by their ability to purchase health insurance) is like promoting the growth of a cancer instead of killing it.

Can you go to a hospital in India or the Phillipines and get free treatment?

In India, you could get free admission in the state run hospitals but that doesn't mean much. I've seen patients lying in beds in the hallways with stray dogs licking their wounds.

Lucky bastards. There are people in the US who long to lie in beds in hallways having stray dogs lick their wounds.

[mawilson 2,133]

....or being put on a sort of 'priority list' for treatments or specialist appointments...such as who gets the dialysis machine/chemo/radiation/mri first. It's all wrong. Socialized, private...whatever, it's unfair and BOTH ways are centered around money. You pay one way or another-with money on premiums or roulette with your life wondering if you actually are getting the best care available to give you the best chance- wondering if the place you are in is going to cut corners, miss stuff or not test for stuff because it's not in their budget for the quarter.

typos

Exactly.

No insurance company (or the government) is going to pay for everything and give everyone

the best care available. Health care will be rationed one way or another - whether it's the

government doing the rationing or a private insurance provider, someone will end up getting

the short end of the stick.

[HAL 9000 96]

All it takes is to change the bankruptcy laws so people can't just bum out of their obligations. You just put them into debt for the rest of their lives and this bankruptcy due to medical bills discussion will go away. Many of the debtors have perfectly good organs they could sell to pay up. That would be a lot better than communist "solutions". There, I said it.

Can I run on a GOP ticket now?

Cleo approves this message.

I don't. Instead of selling their organs (how barbaric!), why not just stop treating people who cannot pay?

Problem solved - no more emergency room freebies.

What are you going to do with all the dead/dying people? I don't want them cluttering up the streets and stinking the place out.

No, much better to make a profit and increase the availability of high quality organs. Win/win.

Harvest the meat.

[Mr. Big Dog 10,747]

Got insurance? No? Then show us your assets / proof of income. Can't? Sorry, can't help you.

Agreed. To treat and prolong the lives of people who add no value to society (as measured by their ability to purchase health insurance) is like promoting the growth of a cancer instead of killing it.

....or being put on a sort of 'priority list' for treatments or specialist appointments...such as who gets the dialysis machine/chemo/radiation/mri first. It's all wrong. Socialized, private...whatever, it's unfair and BOTH ways are centered around money. You pay one way or another-with money on premiums or roulette with your life wondering if you actually are getting the best care available to give you the best chance- wondering if the place you are in is going to cut corners, miss stuff or not test for stuff because it's not in their budget for the quarter.

Or, of course, you can also pay top dollar - as the US population overall does - and still get shite in return. Getting the worst of both worlds, so to speak. It's not like people here ain't dying waiting for something as routine as a dialysis.

When dialysis waits, doctor loses patience

Kris Hundley, Times Staff Writer

Published Friday, June 12, 2009

James Harold Bischoff was admitted to Largo Medical Center the day after Christmas with acute kidney failure.

As the 70-year-old's condition deteriorated, a kidney specialist ordered dialysis, saying it was critical Bischoff get excess potassium and fluid filtered out of his blood quickly.

The dialysis never took place.

The doctor ordered Bischoff's dialysis to begin no later than 6 a.m. on Dec. 28. The order was called in to Fresenius Medical Care — the outside vendor that performs dialysis at the hospital — at 2:30 a.m.

At 9:40 a.m., the dialysis nurse called to say he would be late.

He arrived at 11 a.m., as doctors and nurses were trying to revive the patient, whose heart had stopped.

By 11:18 a.m., Bischoff, a loner who lived in a trailer park in Largo, was dead.

His specialist, Dr. Abraham Awwad, got a voice mail about noon from the Fresenius nurse. "He said, 'I came to dialyze your patient but they were running code and he expired. Call me if you have any questions,' " Awwad said. "If dialysis had even been started by 8 a.m., Mr. Bischoff would still be with us today."

The December death at Largo, an HCA hospital, opens a window into the practice of outsourcing critical inpatient services like kidney dialysis. Though lots of local hospitals do it, the death at Largo shows how high the stakes can be for a seemingly routine procedure.

Dialysis can be postponed for some patients, Awwad said, but timely treatment is a life-and-death matter for people who have fluid overload in their lungs, congestive heart failure or, like Bischoff, dangerously high potassium levels.

State inspectors found serious deficiencies in Largo's dialysis program. But the whole episode would have remained buried in official records — with even Bischoff's closest relatives unaware — if his specialist hadn't decided to speak out.

Awwad, who has a reputation among colleagues for being both passionate and a pain in the neck, says there still are problems with contracted dialysis services at local HCA hospitals.

"I'm not walking away from this,'' he said. "I anticipated something like Mr. Bischoff's death could happen if doctors have no say in dialysis. But nothing was done."

Limiting cost, control

The state's investigation at Largo came less than a year after regulators suspended dialysis services at Northside Hospital, another Pinellas HCA facility. The forced closure followed months of physicians' complaints about the outside dialysis provider. HCA responded by promising improvements, including hiring a new dialysis company: Fresenius.

HCA says all is well at both Northside and Largo. "At the present time, there are no issues with Fresenius," said spokeswoman Tammy Robiconti.

Fresenius, which also operates an extensive network of outpatient dialysis clinics, did not respond to the Times' calls concerning Bischoff's death or its hospital contracts.

Contractors such as Fresenius provide everything from dialysis machines to tubing to fluids to personnel, saving hospitals money. But they also limit doctors' control over the procedure.

Dr. Jacques Durr, head of nephrology at the University of South Florida's College of Medicine, converted the dialysis program at Bay Pines VA from an outsourced to an in-house program, a move he said proved cost-efficient, while improving care. He currently sees patients at Moffitt Cancer Center, which contracts with Fresenius, and Tampa General Hospital, which has an in-house dialysis unit.

"If a hospital does cardiac surgery or intensive care, it would be better to have dialysis done in-house," Durr said. "But we also have to live with the reality of the world and what a hospital can afford."

Awwad, who did his nephrology fellowship at USF, said HCA has refused to discuss creating an in-house dialysis program for its five Pinellas hospitals. He also disputes HCA's statement that it involved doctors in the selection of Fresenius as its contractor.

"The administrators just told us they'd brought in a new 'vendor,' like Burger King selecting someone to supply the ketchup," he said. "The experts were kept out of it. We never even saw the contracts."

How long of a wait?

Sitting in the lunch room of his St. Petersburg office recently, Awwad shuffled through a stack of patient files. Each one, he said, contained an incident of dialysis care gone wrong.

In February, less than two months after Bischoff's death, Awwad ordered a stat or emergency dialysis at 1:40 a.m. for a Largo patient. When a Fresenius worker had not arrived by 3:30 a.m., the Largo supervisor made a follow-up call. Fresenius' response was that, according to its contract with Largo, its staff has four hours to respond to a "stat" dialysis order. The Fresenius nurse arrived at 4:45 a.m.

Though the patient was successfully dialyzed, Awwad said the delay was potentially dangerous. Dr. Gerald Schulman, head of nephrology at Vanderbilt University Medical Center in Nashville, agreed.

"I wouldn't want to wait four hours to treat somebody in an extreme situation," said Schulman, a member of the American Society of Nephrology's Dialysis Advisory Committee. "If they had very high potassium levels, difficulty breathing or fluid overload, a four-hour wait is not acceptable."

Awwad said he also has had patients who received treatments without a doctor's orders or had their session cut short.

Dialysis treatments usually take three-and-a-half to four hours. Awwad said if fluid is taken too quickly from patients, their blood pressure can drop, causing dizziness or an irregular heart rhythm. If the session is terminated earlier than ordered, the blood won't be adequately cleansed and excess fluid will remain in their system.

"These outside contractors want a dialysis treatment that's 'one size fits all,' but it has to be fine-tuned to the needs of the patient," Awwad said.

Last month at Northside, Awwad learned a Fresenius nurse ended dialysis 30 minutes earlier than ordered, though it appeared in the patient's chart as if the full treatment had been received. The doctor, who had quality issues with the same nurse in the past, complained to Northside's management.

Awwad also noted in the chart that the patient, her mother and her 17-year-old daughter said dialysis had been abbreviated and a formal incident report was required.

In response, Awwad received a letter from Northside's chief medical officer, Dr. Charles Nutinsky, who said Fresenius had investigated the incident and fired the nurse. But Nutinsky suggested Awwad shouldn't leave a paper trail of complaints in the patient's record.

"I want to thank you for bringing your concern to our attention while at the same time request that a phone call or communication other than on the hospital chart be considered in the future," he wrote.

Nutinsky did not respond to calls or an e-mail from the Times.

Pushing for change

Awwad believes Northside already retaliated against him once, granting him staff privileges for just one year rather than the standard two after he complained about the former dialysis company. But Awwad, 49, does not give up easily. He lost his right eye in a motorcycle accident six years ago yet just bought a new Harley-Davidson, Being an outsider is part of his upbringing as a Palestinian Christian who was born in Jerusalem and moved to Miami at 14.

"I want to pressure them to make a change," said Awwad, whose practice is largely dependent on local hospitals.

While Awwad said colleagues share his concerns, none of his fellow nephrologists at HCA returned calls for comment.

The internist who cared for Bischoff, however, supports Awwad. Dr. Michael Saccente agreed that his patient would have lived if dialysis had been received. "There was no care from a dialysis standpoint," he said.

Saccente, who shares office space with Awwad in Largo, was also present at a meeting of the hospital's medical staff in February to discuss Bischoff's death. Before the meeting started, Largo's chief of staff "verbally assaulted" Awwad, the internist said, for having called in the middle of the night after yet another patient's dialysis was delayed.

"Dr. Awwad simply wished to speak with a physician in a position of power and then he gets that response,'' Saccente said.

Chief of staff Dr. Larry Feinman said recently he didn't know about continuing complaints about dialysis. "I did not expect to get in the middle of this," said Feinman, a vascular surgeon.

New chain of command

Durr, the director of USF's nephrology fellowship, is not surprised to hear that his former student is making waves.

"Dr. Awwad was very caring of his patients and always put them ahead of hospital politics," Durr said. "I'd rather have a physician speaking out, even if he becomes a pain in the neck, than have someone who does nothing when they see something that endangers a patient."

Awwad's complaints about Bischoff's care resulted in a state investigation, discipline of the night nurses in the case and a new "chain of command" when dialysis is delayed.

But no one told Bischoff's closest relative, second cousin Nanci Bender, about the controversy surrounding his death. Bender, who lives in Odessa, said she wasn't close to Bischoff, a bachelor and alcoholic. "I'd see him on holidays, but Jimmy didn't really associate with the rest of the family," she said.

Bischoff was taken by ambulance to Largo after a neighbor found him unconscious in his mobile home. Bender didn't know Bischoff had been hospitalized until the day he died.

"I called Largo hospital sometime between 10 and 11 a.m. and they said they'd call back," she said. "That night about 10 p.m. they said he was deceased." She still has his ashes in the back seat of her car.

Bender only recently read the state's investigation into Bischoff's death. "He should have had decent care," she said.

Edited July 8, 2009 by Mr. Big Dog

[HAL 9000 96]

Got insurance? No? Then show us your assets / proof of income. Can't? Sorry, can't help you.

Agreed. To treat and prolong the lives of people who add no value to society (as measured by their ability to purchase health insurance) is like promoting the growth of a cancer instead of killing it.

Can you go to a hospital in India or the Phillipines and get free treatment?

In India, you could get free admission in the state run hospitals but that doesn't mean much. I've seen patients lying in beds in the hallways with stray dogs licking their wounds.

Lucky bastards. There are people in the US who long to lie in beds in hallways having stray dogs lick their wounds.

Nice doggies. Showing their healing powers.

[mawilson 2,133]

Got insurance? No? Then show us your assets / proof of income. Can't? Sorry, can't help you.

Agreed. To treat and prolong the lives of people who add no value to society (as measured by their ability to purchase health insurance) is like promoting the growth of a cancer instead of killing it.

Can you go to a hospital in India or the Phillipines and get free treatment?

In India, you could get free admission in the state run hospitals but that doesn't mean much. I've seen patients lying in beds in the hallways with stray dogs licking their wounds.

Lucky bastards. There are people in the US who long to lie in beds in hallways having stray dogs lick their wounds.

Unacceptable! Hospitals should not provide free access to stray wound-licking dogs unless

the patient's insurance includes stray dog wound licking as a covered benefit.