Medical Extortion, Fake Awards, and Assaulted by an ER Nurse
In I Experienced America's Broken Healthcare System While Looking Up From a Hospital Gurney, Steven Brill, author of America's Bitter Pill, seems to morph somewhat from a fierce critic to being somewhat sympathetic to what I view as extortion when frightened patients or family members pay whatever hospitals demand to save them. Hospitals prey upon people at their most vulnerable times, and it is dead wrong.
Here is an example, loosely based on a true story: I worked in some major hospitals, but this wasn’t one of them; this was a tiny hospital with a micro ER staffed by a whopping two people: me and a nurse.
I’d asked him the week before, “Don’t you ever get any codes in here?”
I’d worked there several months and hadn’t had one code yet. When I worked in big-city hospitals, I might have several codes per day, treating patients in cardiac arrest.
Then three cars (not ambulances) pulled up at the same time, all carrying people whose hearts stopped at home. All were unrelated cases—their simultaneous arrival was a bizarre coincidence, like an ER version of a celestial syzygy.
My question was answered: yes, they do get codes.
In this case, with one nurse I couldn’t possibly save all three, so I quickly examined them and used what little history I had available to judge which patient had the greatest chance of survival—not that any had good odds: at that time, 95% of people who coded (their hearts stopped) at home died even if they were treated in an emergency department. Incidentally, that 95% statistic includes many people who received CPR and even ACLS at home and in ambulances on their way to the hospital. In this remote area, with people often living far from the hospital and with none of the patients having CPR before arrival, the chance of saving any was close to zero.
Abysmal odds or not, I saved one patient; if the nurse and I tried to treat two or more, they all likely would have died; it takes at least two people to properly code one patient according to ACLS protocols.
When I worked in a major hospital with a big ER staffed with many (but usually never enough) nurses, I had another case where I coded three patients at the same time because I had enough nurses that day. I ran from patient to patient, giving orders, and I saved all three. I wish I could have saved all three in the tiny hospital, but it didn’t have enough staff or even a security guard—that’s a story for another day.
What I wrote so far is all true. Now imagine this scenario: one of patients is Bill Gates, and his wife Melinda is begging me to treat him, not the others. If a doctor’s heart were as cold as some businessmen, such as the healthcare CEOs I mentioned in Hospital bills are routinely inflated, and if they had no qualms about Machiavellian-type extortion, the conversation might go like this:
GREEDY UNETHICAL DOCTOR: How much money do you have?
MELINDA GATES: $80 billion, maybe more.
GREEDY UNETHICAL DOCTOR: How much will you give me if I save his life, or even try to? I could instead code one of the other two people, you know.
MELINDA GATES: Is $1 million enough?
GREEDY UNETHICAL DOCTOR: The blue girl you see is the daughter of J. K. Rowling. She’s a billionaire, too, and offered me much more, plus all of her future income. Isn’t Bill’s life worth $10 billion to you?
Ethical? Of course not. When I chose which patient to code, I didn’t factor in who had the nicest car or clothes or some other proxy indicator of money; I used my best medical judgment to assess probability of survival and remaining years of life (say if all had approximately equal odds but two were elderly and one was three years old, I’d save the child to save more years of life).
Image by StephanieFrey, bigstockphoto.com
But in the real world, everyone dies, even billionaires. Bill Gates’s heart might stop while he is in some small sleepy town, and he might be brought to the ER at the same time as another patient or two with no pulse. And some doc will decide whom to code. And Melinda might try to influence him. Bill is counting on it, because despite all his money and experts, he doesn’t have one like me who could obviate such a choice. Bill’s a gifted thinker, but he hasn’t thought this one through; it’s not his bailiwick.
I’ve treated many famous and very wealthy patients. When I did that, it never occurred to me to ask for a penny more because that would be highly unethical and even illegal, in my opinion (if it isn’t, it should be, because it boils down to extortion). Yet it would be so easy to do, and I could tell you the name of a nurse who had piles of money showered on her after treating a rich man—and it wasn’t because she was very smart, attractive, or even nice.
Some other day, I could also you about how patients can be extorted by direct or implied threats. When you consider the percentage of the population that is sociopathic and realize healthcare workers are not immune, the fact that some use their power to extort patients is not surprising.
With this as a theoretical preface, consider the ramifications of what Steven Brill seemed to suggest in I Experienced America's Broken Healthcare System While Looking Up From a Hospital Gurney: because patients are so desperate to receive the healthcare they need to live, greedy hospital executives eager for more money can fleece them—and because life is so precious, maybe we shouldn’t be too upset when they take way too much precious money from us, or our homes and other stuff as we’re bankrupted and surrender a lifetime of earnings to settle a single hospital bill.
This riles every ethical bone in my body! Anyone taking advantage of vulnerable patients should have his/her license revoked and then do 20 years hard labor. Although it is wrong, such shakedowns occur every minute of every day in American hospitals, in which caring for patients is less important to top administrators than extracting as much money as they can from patients or their insurance companies, as I discussed in Hospital bills are routinely inflated. If those charges were even semi-reasonable, I wouldn’t discuss it, but because they aren’t, I’ve written about this for years.
Hospitals and some doctors are such vultures that even when I spent days negotiating a price in advance, the bills I received totaled almost three times the amount we agreed upon! If a doctor as a patient cannot overcome their slimy underhanded tactics, what chance does a typical patient stand?
Hospitals know they are in the driver’s seat, so they run over patients every chance they can so their CEOs can live like kings and cozy up to beautiful young women, as I wrote in Hospital bills are routinely inflated.
Routine hospital fleecing of patients is not acceptable because it is less egregious in individual cases than demanding $10 billion from Mrs. Gates to save Bill, just as it is not OK to punch someone in the nose because that is much better than shooting them. Wrong is wrong, period.
Oddly, when politicians talk about medical costs, they tacitly assume the charges are usually legitimate, not inflated, but they haven’t a clue as to what goes on in hospitals. Politicians and so-called experts may talk about millions spent for high-tech equipment that lasts for many years, but rarely if ever do they talk about millions spent yearly on hospital CEOs so they can live the high life by robbing patients.
Ultimately, we give top politicians power because they should know much more than we do: that is the basis justifying representative democracies. However, in this case involving healthcare—one of our greatest expenses—our politicians are utterly clueless, unable to dissect hospital bills to know what is fat. And hospital CEOs are laughing all the way to the bank, and sometimes the bedroom with pals paid for by patients.
If you were a doctor and had a grown man call you at home crying about a hospital bill, as I have, you’d do something about it—and I am.
The hospital award racket
The deeper I dig into the hospital industry the more dirt I find. I previously assumed hospital awards were legitimate until I worked at a place that claimed it was one of the top cardiology hospitals in the country. That’s odd, I thought, we had no cardiologists on staff and no CCU; just a tiny all-purpose ICU. We had a couple internal medicine docs who fancied themselves cardiologists, but hey, I can read EKGs and insert invasive cardiac pacemakers (temporary ones, anyway), and I’m not a cardiologist. I’m also great with suture, but I’m not a plastic surgeon.
I didn’t think much about hospital awards until years later when one claiming to be one of the top hospitals in the country put too many of my friends and family into their graves too soon after too many stupid mistakes.
I never worked at that hospital but I knew about them because I’d transferred many patients there—or tried to—while working in the place boasting it was one of the top cardiology hospitals in the country though it lacked a cardiologist and so much more. With so many voids, I and other ER doctors often needed to transfer patients to larger hospitals, but dealing with this one drove me nuts because docs on the receiving end were often such crybabies (such as by blabbering about their call schedules—as if I made them or patients should suffer because of them) I gave up in frustration and transferred patients to another hospital, further away and smaller.
After one of my friends went to the supposedly top hospital for what should have been a routine stay but left in a body bag, his wife called and said she never received a bill for his care even though she knew their insurance coverage wouldn’t pay everything. She thought it was odd and an admission of guilt but likely them hoping to placate her anger by not billing her.
Trust me, hospitals do not forget to bill patients! When they do, it is tantamount to saying, “Can’t we be friends? Can’t you overlook the loved one we killed? Just keep the money you otherwise would have paid us and show a bit of gratitude by not suing us. Friends, okay?”
Assaulted by an ER nurse
To make a long story short, this hospital excelled in hiding its mistakes, not caring for patients. My suspicion grew even more when I accompanied my Aunt (as a relative, not as a doctor) bleeding to death and gasping for breath (because she’d lost so much blood) to the supposedly top hospital’s ER. As she tore off her gown and screamed that she couldn’t breathe and was dying, I suggested applying oxygen.
While that seems more than a little obvious, it wasn’t to the male nurse. In fact, he began arguing why oxygen wasn’t needed.
Tell me, nurse, what do the other Martians think?
I thought that but didn’t dare say it, knowing how idiotic it is to antagonize healthcare workers. Instead, I calmly but briefly explained why his explanation was wrong. Evidently incensed by logic and facts he couldn’t refute, he forcefully threw an oxygen mask at me, striking my arm so hard it stung for an hour, angrily telling me to put it on her. As bad as that was, what was even worse was when that hospital did nothing but sweep the problem under the rug.
And this is a top hospital? On what planet?
I had other bad experiences with them, such as a phlebotomist who didn’t properly draw my blood and an ultrasound technician who did not properly wash her hands even after I repeatedly explained what she did wrong. Haven’t they heard of germs?
Now very curious about how hospitals staffed with lazy second-rate doctors, at least one nutty nurse, an incompetent phlebotomist, an ignorant and stupid ultrasound technician, and out-to-lunch administrators (since they are so clueless, they clearly do not deserve to be showered with gold, as I discussed in Hospital bills are routinely inflated) skilled in hiding problems could possibly be a top hospital, I dug into the hospital award business and concluded it was a racket in which administrators play clever games along with award issuers—all engineered to disguise the link between payments by hospitals and awards given to them, all for one goal: so administrators can use such designations of excellence (fraudulent as they are, in my opinion after months researching this topic) to justify higher salaries for themselves.
The FBI proudly recalls how they stopped Mafia gangsters that bled comparatively few Americans, yet they and the rest of our government sit idly by, blind as a bat, while hospitals rob everyone. Oh, and you folks who fancy yourself as professional journalists: isn’t it time for some good old-fashioned investigation?
There is so much fodder for journalists to win Pulitzer Prizes, but years after giving them another dandy (healthcare workers sexually abusing women and intentionally killing patients because they are black), not one showed the slightest interest. There’s always something more pressing to cover, such as Kim Kardashian or underinflated footballs. It’s called fiddling while Rome burns.
The only person I know who was ever convicted of a crime was a doctor caught cheating an insurance company. He went to prison for years for his comparatively petty theft while hospital executives who steal much more get off scot-free. This is consistent with the American injustice system that hammers small thieves while the big ones, such as hospital executives and Wall Streeters, are given a pass, institutionalizing their crimes. The following sentence explains why hospitals have a license to steal:
“… the healthcare industry spends four times as much on lobbying as the number two Beltway spender, the much-feared military-industrial complex.”
— Journalist Steven Brill, author of America's Bitter Pill, in I Experienced America's Broken Healthcare System While Looking Up From a Hospital Gurney
In a subsequent article, I will provide evidence that even the President of the United States is controlled by money.
Hospital CEOs and presidents paid like kings hope the communities they rob are too distracted to realize how all the gold given to them could instead be used to pay them reasonable* salaries so better care could be given to patients. They hope people think they can take that gold and no one pays a price for it, but I can tell you true story after true story about people who did suffer, such as a child who lost an eye, people who lost their lives, and a woman married to a doctor whose brain was injured because of a hospital mistake, giving him the mental ability of a small child trapped in an adult’s body.
*What might be a reasonable salary for a hospital CEO or president? If they want a penny more than what an average doctor makes, make them justify it—and not with a fake award they essentially purchased, thus diverting even more money from patient care toward a silly token that camouflages dangerous problems. The best hospitals are the least likely to play the hospital award game, because it is one in which patients lose. Dollars spent chasing fake awards can’t be used to treat real patients. If hospital CEOs and presidents were as smart as they think they are, and if they deserved even 10% of what they are paid, they would have figured that out long ago. It’s not rocket science.
Jobs for former cheerleaders and ex-models
With healthcare being such a deadly serious business, you might think everyone in it would do whatever is best for patients. Here is another example of how that is not true: instead of hiring the smartest and best educated people to speak with doctors about their drugs, pharmaceutical companies prefer ex-cheerleaders and models!
Testifying before Congress, Shahram Ahari, a former pharmaceutical representative, indicated that “drug companies like hiring former cheerleaders and ex-models to wine and dine doctors, exaggerate the drug's benefits and underplay their side-effects.” He said his job involved “rewarding physicians with gifts and attention for their allegiance to your product and company despite what may be ethically appropriate.” He added they use “friendships and personal gifts to foster a "quid pro quo" relationship, and how to exploit sexual tension.”
And how!
Conclusion
American healthcare is an ethical cesspool with the most powerful people in it strangely mum about its flaws because playing the game is more profitable than ending it.
“Politicians regard the public as a cow to be milked …”
— Elbert Hubbard