This is a letter of outrage, indignation and another emotion that I have yet to identify. It's always been my policy to support local government and quasi government agencies, such as the hospital, on the presumption that they do an overall good job and have enough detractors that they need an occasional pat on the back to compensate for some of the criticism, and let them know that
the public, for the most part, is supportive of them. However, there are times when even a man of my gentle, forgiving nature, (ask my ex wives) must quit being Mr. Nice Guy and give in to the temptation to rant and rave.
This is a follow up to my letter of Dec. 1 detailing my experience in the Carson-Tahoe emergency room. I was at the emergency room for approximately two hours with possibly 20 minutes of that actually being treated; the rest waiting. While cooling my heels, I looked out the door of my holding room and was able to watch some of the activity as medical personnel cared for the needs of the many people who streamed in and out. The patients were an interesting assortment. Some, such as myself, stoically and quietly awaiting treatment so we could be released and rush to take advantage of what was left of the happy hour; others who hadn't waited and were boisterously giving the
staff a hard time. There were parents with small children and babies going through, for the first time, the learning experience of being certain that their kids were dying and being assured by the caring, competent staff that they would be OK. There were older people suffering from lung and heart conditions whose regular treatment broke down, requiring them to seek immediate attention. Then there were people who didn't seem to have any life threatening or obvious need for immediate treatment.
The Triage Team, whose responsibility is to examine each person immediately upon arrival and determine the seriousness of each patient's needs and schedule them for further examination, did an excellent job both in determining the actual needs and in convincing those of us who could wait that there was no need to update our wills or start phoning to arrange for a cemetery plot. In all, the staff did a fine job, both as medical providers and amateur psychologists.
My quarrel is not with the personnel but rather with the billing practices. My injury ( a chunk of skin torn from my hand) was obvious and required no diagnosis, testing or anything else other than applying a topical antibiotic and closing the wound, a procedure that took the attending physician
approximately 10-15 minutes total time. I was billed $160 for this. The physician correctly determined that the skin on my hand was too thin to hold stitches and elected to use pharmaceutical grade Crazy Glue to close the wound. Any would-be handyman is well aware of the bonding characteristics of
Crazy Glue. While it is seldom effective in linking whatever needs to be bonded, it is without peer in sticking fingers together. I once glued my finger to my other hand and was obliged to suffer the humiliation of asking every woman in sight if she was carrying any nail polish remover before I
could unstick it and drive home. Changing the name of the adhesive from Crazy Glue to Dermabond (and possibly making it a bit more sterile) allowed a price increase from around $2 to $73 a tube, less than one-fourth of which was used. The two hour use of the emergency room cost $76, a figure that would buy an all night stay in many of the better motels. The total bill came to $309. I'm well aware that operational costs must be a part of the bill, but still the billing should be somewhat in relationship to the service provided.
As mentioned at the beginning of this letter, I felt outrage, indignation and a third, unidentified emotion which I have since determined to be frustration. Frustration at my inability to determine just who is responsible for the outrageous increase in all aspects of medical care. I must point to the heavy hand of Medicare which ultimately dictates everything from insurance premiums, to fees charged, to determining what constitutes a medical emergency when a person is transported by ambulance. Medicare's unreasonable determinations in this area has cost the city $147,000 recently
and is threatening to bankrupt our ambulance service. This is a whole different can of worms that I'll cover in detail in a future letter. The public must quit taking ever increasing medical costs as a fact of life and start raising hell about it. The best place to start is with our congressmen and senators. Write, call, e-mail, make contact anyway you can and demand that they tell you what they intend to do about Medicare and its unreasonable control over our health and welfare. Insist on an answer.
DENNIS RITCHIE
Carson City
