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She didn’t get treated at the ER, but she got a $5,751 bill anyway

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CrossCheck    324
20 hours ago, jnelsoninjax said:

What was the ice made from, gold? :D Seriously the ER's prices are outrageous!

It was gluten free water

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+jnelsoninjax    12,055
6 minutes ago, CrossCheck said:

It was gluten free water

Oh, makes sense then! :D

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sidroc    1,201
34 minutes ago, Xilo said:

 

You have done nothing but misread and assume way way too much in this thread. 1) It was the only thing open. 2) We had no insurance. 3) Just because we left doesn't mean I wasn't really sick/in horrible pain/etc.

 

I'm honestly surprised you're defending our countries crappy health care system.

You left Against Medical Advice. I'm sorry you did not have insurance. But that has nothing to do with your decision to leave AMA. You said they did nothing for you, you did not let them because you left. I am licensed in Canada as a nurse and in the process of immigrating at this time. I know the problems with our healthcare system, but leaving AMA while your right to do, does not help your case.  I'm defending the nurses and doctors you say did nothing for you. Unless you want to say nurses and doctors themselves are the problem. 

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adrynalyne    12,281
4 hours ago, Xilo said:

 

You have done nothing but misread and assume way way too much in this thread. 1) It was the only thing open. 2) We had no insurance. 3) Just because we left doesn't mean I wasn't really sick/in horrible pain/etc.

 

I'm honestly surprised you're defending our countries crappy health care system.

It’s what pays him, of course he does. 

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sidroc    1,201
11 hours ago, adrynalyne said:

It’s what pays him, of course he does. 

This is the attitude that allows nurses to be assaulted in the ED at some of the highest rates of any profession. We have nothing to do with the billing and yes we did do allot for you even if you did not see it. If you can't delineated between the cost of living in a private medical system and the services provided by individual nurses and doctors then I don't know what else to tell you. Don't hate the nurses and doctors, hate the system that they have to work in and there perameters of that system. 

Edited by sidroc
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adrynalyne    12,281
2 hours ago, sidroc said:

This is the attitude that allows nurses to be assaulted in the ED at some of the highest rates of any profession. We have nothing to do with the billing and yes we did do allot for you even if you did not see it. If you can't delineated between the cost of living in a private medical system and the services provided by individual nurses and doctors then I don't know what else to tell you. Don't hate the nurses and doctors, hate the system that they have to work in and there perameters of that system.

what attitude? You are a nurse defending the system that pays you, even though you said you wouldn’t. That’s not an attitude, that’s pointing out reality. I don’t hate you nor nurses for it. Just pointing out that if it quacks like a duck..,

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sidroc    1,201
14 minutes ago, adrynalyne said:

what attitude? You are a nurse defending the system that pays you, even though you said you wouldn’t. That’s not an attitude, that’s pointing out reality. I don’t hate you nor nurses for it. Just pointing out that if it quacks like a duck..,

I have not once defended the amount of her bill, or that she received one. I do not work for any insurance company, and will have similar buying power once working in Canada under a national system. In fact, I favor a move to a national healthcare system as it is the only fair way. What I am saying is that the hospital did provide services to this women beyond what she is claiming. I know this because the hospital would open itself to massive liability if it did not follow the standards of practice that are almost universally recognized. Syncope with head trauma is a patient that will get an EKG, Imaging, and blood work in 100% of competent ER's in the United States, Canada, and the UK. You have to understand how healthcare workers perceive the statement that "nothing was done for me". We take that as an offense and rightly so. The patients and journalists definition of nothing is based in an ignorance of what constitutes medical treatment. It also undermines the fight for a national system when providers and nurses on the fence are accused of doing nothing for a patient with syncope and head trauma. Doctor's are not economist, why should they continue to read articles promoting a National System when they accuse them and nurses of doing nothing for patients that need a workup.

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adrynalyne    12,281
8 minutes ago, sidroc said:

I have not once defended the amount of her bill, or that she received one. I do not work for any insurance company, and will have similar buying power once working in Canada under a national system. In fact, I favor a move to a national healthcare system as it is the only fair way. What I am saying is that the hospital did provide services to this women beyond what she is claiming. I know this because the hospital would open itself to massive liability if it did not follow the standards of practice that are almost universally recognized. Syncope with head trauma is a patient that will get an EKG, Imaging, and blood work in 100% of competent ER's in the United States, Canada, and the UK. You have to understand how healthcare workers perceive the statement that "nothing was done for me". We take that as an offense and rightly so. The patients and journalists definition of nothing is based in an ignorance of what constitutes medical treatment. It also undermines the fight for a national system when providers and nurses on the fence are accused of doing nothing for a patient with syncope and head trauma. Doctor's are not economist, why should they continue to read articles promoting a National System when they accuse them and nurses of doing nothing for patients that need a workup.

But you don’t know this because you weren’t there. Heck, we don’t even know if this story is true. I’ve sat in the ER for 6+ hours in the waiting room only being seen by the people taking money. In the meantime I had an open gash on my head from a car accident  while people with tummy aches were seen. Were some worse off? Sure. Were all of them? Not even close. 

 

Things are not as rosy as you make them seem. 

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sidroc    1,201
5 minutes ago, adrynalyne said:

But you don’t know this because you weren’t there. Heck, we don’t even know if this story is true. I’ve sat in the ER for 6+ hours in the waiting room only being seen by the people taking money. In the meantime I had an open gash on my head from a car accident  while people with tummy aches were seen. Were some worse off? Sure. Were all of them? Not even close. 

 

Things are not as rosy as you make them seem. 

Your not a triage nurse, I work triage and have spent 100's of hours in it. We have a scoring system known as Emergency Severity Index (ESI) that we are required to attend classes on. I can assure you we follow it and if someone went back first they had a reason too. Triage exists in the UK and Canada as well and they also use a 1-5 scoring system (Canadian Triage and Acuity Scale and the Manchester Triage System). I also do know this, unless this ER is not following the standards set forth by governing bodies I do know this. I also happen to know base price for no treatment in American ED is not >5000$. It is expensive, but for a under  day visit, you don't reach >5000$ without services outside of walking in and leaving being rendered. They should post the bill if they have any credibility.

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adrynalyne    12,281
3 minutes ago, sidroc said:

Your not a triage nurse, I work triage and have spent 100's of hours in it. We have a scoring system known as ESI that we are required to attend classes on. I can assure you we follow it and if someone went back first,t hey had a reason too. I also do know this, unless this ER is not following the standards set forth by governing bodies I do know this. I also happen to know base price for no treatment in American ED is not >5000$. It is expensive, but for a under  day visit, you don't reach >5000$ without services outside of walking in and leaving being rendered. They should post the bill if they have any credibility.

I don’t have to be a triage nurse. What you do have to do, is be there to know what you claim to know and you were not. You can’t assure anything. There are some truly garbage hospitals out there. We are going in circles here so there isn’t a lot of point in continuing. 

 

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sidroc    1,201
4 minutes ago, adrynalyne said:

I don’t have to be a triage nurse. What you do have to do, is be there to know what you claim to know and you were not. You can’t assure anything. There are some truly garbage hospitals out there. We are going in circles here so there isn’t a lot of point in continuing. 

 

If they can show that nothing was done at all for her, then I can agree, as this patient deserved a full workup. No one said there is no bad apples, what is being said is that this story does not add up at all. They should post the bill if they are so confident as the hospital cannot as it is bound by HIPPA. The patient could give the hospital permission to speak about her case but clearly she hasn't).

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Matthew S.    1,024
3 minutes ago, sidroc said:

Your not a triage nurse, I work triage and have spent 100's of hours in it. We have a scoring system known as ESI that we are required to attend classes on. I can assure you we follow it and if someone went back first they had a reason too. Triage exists in the UK and Canada as well and they also use a 1-5 scoring system. I also do know this, unless this ER is not following the standards set forth by governing bodies I do know this. I also happen to know base price for no treatment in American ED is not >5000$. It is expensive, but for a under  day visit, you don't reach >5000$ without services outside of walking in and leaving being rendered. They should post the bill if they have any credibility.

I've had first-hand experience with nurses screwing up with ESI in Canada, and also the first-hand experience with screwing up with car crash victims (why the ###### would an ER put two drivers (my mother and the at-fault ######) from the same accident next to each other in the same waiting room is beyond me...)

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adrynalyne    12,281
1 minute ago, sidroc said:

If they can show that nothing was done at all for her, then I can agree, as this patient deserved a full workup. No one said there is no bad apples, what is being said is that this story does not add up at all. They should post the bill if they are so confident as the hospital cannot as it is bound by HIPPA funny enough, the patient could give the hospital permission to speak about her case but clearly she hasn't).

She has no reason to, the charges were dropped as soon as a reporter contacted them. So while it would be nice, she got her way already. I wonder what would happen if I tried this next ER visit ;) Kidding of course. 

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sidroc    1,201
35 minutes ago, Matthew S. said:

I've had first-hand experience with nurses screwing up with ESI in Canada, and also the first-hand experience with screwing up with car crash victims (why the ###### would an ER put two drivers (my mother and the at-fault ######) from the same accident next to each other in the same waiting room is beyond me...)

 

That's not part of triage, where you sit in the waiting room is up to you. I have never seen assigned seating in a waiting room at any ED in Canada, or the US. Again, this is quickly turning into an attack on healthcare providers, not the system. If there is a problem, we call security.

33 minutes ago, adrynalyne said:

She has no reason to, the charges were dropped as soon as a reporter contacted them. So while it would be nice, she got her way already. I wonder what would happen if I tried this next ER visit ;) Kidding of course. 

 

She had every reason not to allow the hospital to comment on her case as it ties the hospitals hands such that it cannot make a public statement. HIPPA is extremely restrictive in this regard.

 

I will provide  story that has a basis in a real events to explain triage a bit. 

 

Patient reports with deformity to arm. Triage nurse checks for pulses and changes to sensation. Patient has Both is assigned a ESI 3 and placed in the waiting room. An hour goes by, a patient comes in with intractable abdominal pain described as a tearing sensation. A review of the chart sees that the patient is not a frequent flyer, and hasn't been to the ED in 6 years. Suspecting a AAA, the nurse places the patient as ESI 2 and takes them back immediately. The earlier patient is not extremely angry "you took the tummy ache back before me and I have a broken arm!". What that patient doesn't realize is that the patient we took back early is possibly minutes away from bleeding out internally. No amount of explaining without violating Hippa would make the patient understand this so the triage nurse just says the patient needed seen sit and wait your turn". 

Edited by sidroc

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Matthew S.    1,024
11 hours ago, sidroc said:

 

That's not part of triage, where you sit in the waiting room is up to you. I have never seen assigned seating in a waiting room at any ED in Canada, or the US. Again, this is quickly turning into an attack on healthcare providers, not the system. If there is a problem, we call security.

 

1

Umm she was confined to a wheelchair when the EMT's brought my mother in, the hospital knew and were the ones whom wheeled her there, so no she did not have a choice of seating or waiting area.

Also, the nurse assigned to my mother knew he screwed up with the ESI when she crashed (she had major internal organ damage) after she told them she was not feeling right.

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sidroc    1,201
1 hour ago, Matthew S. said:

Umm she was confined to a wheelchair when the EMT's brought my mother in, the hospital knew and were the ones whom wheeled her there, so no she did not have a choice of seating or waiting area.

Also, the nurse assigned to my mother knew he screwed up with the ESI when she crashed (she had major internal organ damage) after she told them she was not feeling right.

Again, not part of triage and unless she refused to move her a non issue. Things like that happen. "Screwed up" or the organ damage was not noticeable in triage? Was a seat-belt sign present? Chest pain? Was the abdomen swelling? Was the systolic BP <100? What was the speed of the impact? Is neck pain present? Is a C-Collar needed? What location was your mother in the vehicle hit? I am guessing they did diagnostics, discovered the damage and promptly altered the course of care? Or did they decide to do nothing once the true extent of the problem was found?

 Things do slip past and the standard to judge such an event is given the information available to that nurse, would another similar experienced nurse make the same call. If they would, then the event is just what it is, not everything can be caught by triage because not everything is apparent. A good example, a young man who had abused drugs in his medical history shows up to ER. He states that the room is spinning and he is dizzy for the last 3 hours. He has came in before with vague symptoms that have several times in the past boiled down to drug abuse, lets say hes 25. The triage nurse deduces that the most logical conclusion is that the patient is high on something given the history and presentation and assigns an ESI 3. The patient has no physical or sensory deficits bilateral. PT goes back and when the patient is insistent no drugs where used orders a CT.

Turns out its a cerebellar stroke that could have been caught within the four hour window (evidence varies on the effectiveness of Alteplase in Cerebellar strokes, but some neurologists with try it) . The NIH stroke scale cannot pickup these kind of strokes easily due to their atypical presentation and the patients age is atypical for such a stroke. We get whats called a triage case of the week each week at hour facility to help us catch oddball cases in the future. We always try to improve our practice. It does not mean we are incompetent, or that we do not care.

On the other hand, lets say that they did screw up, provided inappropriate triage, and caused damage to the patient. Not only is that atypical behavior, but is a violation of the medical ethic of Non-maleficence. This is a nurse or doctor who does not represent the vast majority of healthcare workers who come to work to save lives and provide quality care.

Edited by sidroc

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