Saturday, August 22, 2009

$13,020 Medical Waste Discovered Yesterday

This is a true story of a student I saw yesterday. No names with a few changes in specifics because of patient confidentiality rules.

A girl was between insurances this summer. (Once a student graduates from college, they are automatically off of the parents' insurance plan.) While hiking about a month ago, she stepped into a hole and rolled her ankle. She felt a crack as she came down on her foot and ankle. Her uncle the orthopedic surgeon examined her and determined that she probably broke a bone in her foot. She didn't have insurance, so he decided to forego the X-ray to confirm a fracture (cost approximately $80). He bought her a cast from a medical supply store and off she goes.

For a month, she was in a below the knee cast walking around, healing, doing well. Then she moved to Pennsylvania to start graduate school. She had to drive across the country for 3 days. She takes a birth control pill. After arriving in town, she started to experience calf pain. Since she's still walking funny, she really didn't think anything of it.

She finally qualified for her graduate student insurance yesterday. Her uncle told her to come in for her calf pain and to change from her short leg cast to a special shoe. Because of the calf pain, the cross country driving, leg immobilization, and taking of birth control, we decided to check for a blood clot in the leg. It turns out the prolonged immobilization did cause a blood clot. We also decided to get an X-ray to make sure the bone healed well before taking her out of the cast. Ironically, we found out it was never broken. So she's been immobilized in a cast for no good reason. And that no good reason caused her a blood clot in her leg. If she had known that she did not have a fracture, she would not have been immobilized in a cast. She could have avoided this blood clot if she had a simple X-ray. Was it her fault for not paying for the X-ray? Was it her uncle's fault for skipping the X-ray? I think the answer is immaterial because it has happened, and pointing fingers won't solve the problem at hand.

She is now in the hospital getting anticoagulated. She will likely remain there for 4-5 days with IV heparin and becoming stabilized on Coumadin (rat poison to thin her blood). I predict the hospitalization will cost about $10,000. She will need to have a blood test every 6 hours to make sure her blood is thin enough but not too thin ($1000). She will have a CT scan of her chest to make sure she did not have a blood clot travel to her lungs ($1000). She will have an EKG ($200). She will be visited by a hematologist ($1000). She will have have a slew of expensive blood tests to make sure she does not have a blood clotting disorder ($800). She will have a heart monitor and frequent nurse checks due to the anticoagluation ($1500/day on the telemetry hospital wing). She will never be able to take a normal birth control pill again. She may develop chronic leg and foot swelling on that side that will be annoying and predisposed her to getting foot infections for the rest of her life. When she becomes pregnant, she will require extra attention from the obstetrician to make sure she does not develop another blood clot.

After being discharged from the hospital, she will see me at least weekly for six to nine months to check on her Coumadin level. She will have a restricted diet with a strict portion of green leafy vegetables that must be consistent from day to day. She will bruise easier and may have a hard time stopping bleeding if she injures herself. She must not become pregnant during these months because the Coumadin will cause fatal birth defects (which is why it's an effective rat poison). For her 6 months of outpatient care, she will cost the healthcare system about $4000.

To summarize, she did not have insurance so she did not get an $80 X-ray. Now, she will cost student insurance $14,000. Plus, she will have life-long consequences from this avoidable problem. We all end up paying one way or another when there is waste and inefficiency in the medical system. Everyone will end up paying for this episode. And it all boils down to being temporarily uninsured.

Why does our healthcare system cost so much person in the US? In part, it's due to scenarios like this. See my post Healthcare will Bankrupt the Country to see that we spend 2-3 times as much as other countries for worse results. Anyone who tells you we have the best healthcare system in the world is lying to you. She is now worse off for the rest of her life because the healthcare system was not there for her when she needed it.

Again, this is a true story. She was my patient yesterday.

1 comment:

  1. OMG - that is awful. I really feel like sending this little story to someone - just don't know who. The idiots won't listen and the choir has been preached to and is on board.