Patients Who Abuse Hospital Stays

A brash 30-year old man comes into the Emergency Department(ED) with low-grade fever and immediately demands hospital admission. Already annoyed at having made to wait (triaging rightly placed him low down on the wait-list), the patient was carefully examined by the duty doctor who then ordered some essential blood tests. Upon a few hours observation in the sick bay and on receipt of the blood test results, the doctor dutifully explained that there was no medical necessity for the patient to stay in and that outpatient treatment would more than suffice.

Whereupon, turning red in anger, he quickly whipped out his trendy mobile phone and made a call to his father who happened to be the President of a large company which used the hospital as its main referral centre.  In next to no time, the hospital CEO was on the scene and the doctor’s decision was overruled on the basis that the patient represented an important client of the hospital and the hospital needed to maintain ‘good relations’. He was then admitted for investigation of fever, without much justification for in-hospital stay based on mclinical grounds. While in hospital, the patient insisted on a whole battery of expensive tests, including heart-scans, confident that this would be taken care of by his private health insurance policy. Needless to say, upon the patient being discharged, the insurance company rejected the hospital’s bills on the basis that the tests were irrelevant to the illness. Finally, the hospital was forced to absorb the  costs.

Does the above story sound familiar? If you’re a hospital manager or an emergency room doctor, this incident is not unusual at all. Many a time, healthcare providers are faced with a situation like this, where there is abuse of the facilities between  either one (or more) of the three main stakeholders in healthcare delivery: the patient, healthcare provider and the payor (usually insurance companies).

In this particular case, the insurance company was the winner but a similar scenario could arise when a doctor, practising extreme defensive medicine, could have ordered ‘grey area’  investigative tests  at the behest of the patient. In which case, the insurance company would be the loser.

Whichever way it strikes, the ultimate loser is going to be the consumer because there’s no free lunch and everybody’s got to sing for their supper. So, the insurance premiums will keep on rising and consumers will have to dig deeper into their pockets.

Even so, insurance companies are facing huge problems containing costs, given that inflation within the healthcare industry is in double digits. Recently,  more heat occurred in the Oregon summer when an elderly woman with lung cancer was prescribed a $4000 a month cancer drug and was told that ” the Oregon Health Plan wouldn’t cover the treatment, but that it would cover palliative, or comfort, care, including, if she chose, doctor-assisted suicide.”

This is clearly an ethical conflict – denying chemotherapy to terminally ill patients while offering to pay the cost of helping them die.

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9 responses

  1. So very true, here in Malaysia these so called VIP patients will get MPs and lawyers to allow them get free treatment, free meals, and free beds in the hospitals at the expense of the tax payers.

  2. Well written. However, we are always going to have VIPs as long as we have heirarchical organizations. This method of management seems to work well in many cases, and is entrenched and hard to change. I shudder at the thought of an experiment where we change it all at once because I tend to think the status quo is usually better than an unknown.

    The hospital CEO was in a tough spot. Should they ignore and important client? I think not. If the manager thought it was important, he or she could have gone over the CEO’s head. But they wouldn’t for the same reason the CEO agreed to admit the patient. They both value their jobs.

    Similarly, the insurance company acted in its best interests to deny payment for the tests. Overall, I think everyone made out OK even the hospital because they were able avoid negative publicity.

    Doctor2008 says: Thanks.The classic win-win situation? 🙂

  3. A typical example of “VIP Syndrome”. Taken a step further, there are many examples of this syndrome taken to the point of appeasing the VIP to the detriment of his health.

    I’ve heard of and seen the opposite – docs, admins, etc. don’t want to inconvenience the VIP or the VIP itself picks and chooses treatments and diagnostics in some arbitrary fashion, resulting in misdiagnosis and worse.

    Just do a google search for “VIP Syndrome”.

  4. So they come right out and say they won’t pay for her treatment, but they will pay to have her killed? That’s just awful. Here I thought my dental insurance was bad because they will only cover small fillings and having the tooth pulled.

  5. I agree that your post is well written, and describes a real problem. I will describe the opposite extreme: “Hospitalists who abuse patients.” After a late afternoon prostatectomy, competent and attentive nurses and PAs kept all night in the Memorial Hospital recovery room because of an unexpected cardiac problem (SVT). The abuse started shortly after I was taken to the ward floor in the morning. The nurses refused to admit that the urinary catheter was blocked with blood clots, so I suffered all night. After one night in the ward room, a hospitalist came in and yanked out the Jackson-Pratt Drain, applying a bandaid over the abdominal hole. While walking around the ward floor with a nurse’s aide, the bandaid came off and by the time I returned to my room, my hospital gown was soaked with blood. The nurse’s aide put a more substantal dressing over the hole and gave me a new hospital gown. Within half an hour, that dressing was leaking and my hospital gown was soaked with blood again. As I stood naked in my hospital room, the main nurse applying a pressure dressing to try to stop the bleeding, the phone rang. It was my wife. The discharge nurse had called her to tell her that I was ready to go home. When I did not leave immediately, the hospitalist came into my room and berated me for not leaving promptly, suggesting that my insurance might not pay for the additional hours in hospital.

    I did go home, 50 miles away. Three nights later, I was in the emergency room of a suburban hospital with a fever of 39 deg. C., receiving IV fluids and the Cipro that Memorial Hospital had refused to prescribe for me.

    If I had been a VIP, I certainly would have received better care when it was needed.

  6. Your blog is interesting!

    Keep up the good work!

  7. Hey! How is it possible that a doctor can take blood tests, send you to radiology, plus push your stomach in many ways, etc. and tell you that you don’t have anything wrong with your health, even though your stomach hurts like crazy for 2 weeks?
    Well it happened to me, and the outcome wasn’t that pretty… after 2 more weeks my stomach perforated 2 times, and I nearly died… so much for the doctor caring for patients and always acting in their best interest… :((

  8. This is an interesting article. Once I was in hospital , my Mom was terminally ill and stays for long term. Next to her bed was a young girl, in for one night for all sort of tests. She was playing some expensive toys-game, SMS away, calling her friend while she was there, chatting loudly like her very spoilt self at home. It hardly looked like anyone sick enough for admission.

    Then I overheard her parent said during visit hour. Who cares ? Insurance is paying for it, if I don’t use, someone else will… like being self re-assured by her Dad.

    I hope Insurance Company keep a blacklist for those that abused the system,and share them across the industry to shame the abuser and at the same time, charge higher premium for any renewal, or even deny their renewal knowing their nonsense behavior. People like that are the one kept wasting away our limited valuable resources.

    -woody

  9. interesting story ,,
    ,in facti saw the worse
    here in my country even non vip people acting like this and somtimes may beat their doctors and shout in the emeregency room for nothing ,,,and they are complatelly normal ,,,and coming to ER like they go to shopping center !!!!!!!!!!!

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