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| Woman who never saw doctor billed after long Parkland ER wait |
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10/21/2008 - - Amber Joy Milbrodt limped into Parkland Memorial Hospital's emergency department at 10 on a Wednesday night, complaining of a fractured bone in her right leg. She checked in and sat down, wincing with pain as she propped her leg on a chair. She spent all night and the next day in that position, waiting to see a doctor. Tuesday, October 21, 2008 11:03 AM CDT The Dallas Morning News By STEVE THOMPSON This e-mail address is being protected from spam bots, you need JavaScript enabled to view it Amber Joy Milbrodt limped into Parkland Memorial Hospital's emergency department at 10 on a Wednesday night, complaining of a fractured bone in her right leg. She checked in and sat down, wincing with pain as she propped her leg on a chair. She spent all night and the next day in that position, waiting to see a doctor. Finally, she gave up and hobbled out in disgust. Two weeks after her Sept. 24 visit, she received a bill from Parkland for $162. "It should have been more like them paying me for having to sit in the emergency room for 19 hours," she says. "That's just sad. It's not proper. It's almost not moral, what I went through." Parkland officials, already on the defensive about wait times after a man died in the ER following a 19-hour wait last month, say the charge was appropriate because a nurse spent time assessing Ms. Milbrodt for triage. "She's not paying for waiting," says Rick Rhine, the hospital's vice president in charge of billing. "She's paying for the assessment she received." The assessment, which lasted a few minutes, established her place in line that night. The hospital says one in five patients who check into Parkland's ER leaves before seeing a doctor. Those who stay long enough to see a triage nurse must pay. "It's a medical assessment provided by a licensed professional," Mr. Rhine says. "So there's an expense to the organization for providing that care." Volleyball injury Ms. Milbrodt, 29, hurt her lower leg playing volleyball. It still ached the next evening, so she had an X-ray taken at a Dallas chiropractic school where she is a student. She was told she needed to see a doctor about the fracture. So she checked into Parkland's emergency department using an automated kiosk at 10:18 p.m. More than three hours later, at 1:45 a.m., she was called to be triaged. A nurse took her vital signs, checked her blood pressure and asked Ms. Milbrodt to describe her pain on a scale of one to 10. Ms. Milbrodt gave it a seven. It's not clear how long the assessment took, but hospital officials say the average triage evaluation takes six minutes. Afterward, Ms. Milbrodt took a seat in the waiting room. She says she was never told how long she might wait. "Every one or two hours, I would go and be like, 'What's going on? Are we getting any progress? Am I going to see a doctor?' " Ms. Milbrodt says. "And they'd all just kind of brush me away." A hospital staffer gave Ms. Milbrodt a blanket, which she folded up and put under her leg. While sitting there she met others, including a man who crashed a motorbike. "His finger was all bleeding and the nail was completely off," Ms. Milbrodt says. He also waited many hours and before giving up, she says. "He left before me." The following afternoon, Ms. Milbrodt approached a staffer to say she'd been waiting nearly 19 hours. She says the woman responded, "You're not the only one; there are people who have been here 21 and 22 hours." Not long afterward, about 5 p.m., Ms. Milbrodt gave up and left. At 8:57 p.m., nearly 23 hours after her arrival, her name was called several times, but she was gone. Not at every hospital Parkland officials say charging those in Ms. Milbrodt's situation is not unusual. "It's actually industry standard," Mr. Rhine says. "Every hospital I've worked with has done that." Fort Worth's large public hospital, John Peter Smith, shares Parkland's policy. Those who are triaged but not seen by a doctor pay $136. But other hospitals in Dallas don't, including Presbyterian Hospital of Dallas, Methodist Dallas Medical Center and Baylor University Medical Center. "If they don't see a doctor, they are not charged," says Baylor spokeswoman Maria Carpenter. Excessive wait times have plagued Parkland's ER for years. The average patient waits about six hours to see a doctor. But that includes those in critical condition who are seen immediately. Those with less-serious conditions often wait much longer. Last month, about one in every 300 patients waited more than 24 hours. A few days before Ms. Milbrodt's visit, a 58-year-old man who checked in for stomach pains waited 19 hours and then suffered cardiac arrest. Former restaurateur Mike Herrera died Sept. 20 as his family members looked on. Officials say the hospital simply has too few beds for the crush of people needing care. The emergency department has 78 beds, many of which are in hallways. Often, 20 or more are taken up by patients who are ready to be admitted into the hospital but for whom no beds are available upstairs. The problem, called "boarding," contributes to excessive wait times in every major city. Some experts suggest moving these patients from the hallways of emergency departments to hallways throughout the rest of the hospital. "Is it better to distribute that load across nursing units, across different parts of the facility?" says Dr. Arthur Kellermann, a nationally recognized professor of emergency medicine at Emory University in Atlanta. "Or concentrate all of the burden in the most time critical portal of entry into the system, which is what most hospitals are doing today." But other experts disagree, and Parkland officials have rejected the idea. They say that it would be a fire code violation and that simply moving the problem to other areas of the hospital is no way to solve it. A plan to build a new Parkland Memorial Hospital, costing nearly $1.3 billion, is in the works. A bond election is schedule for November. The proposed 862-bed hospital would give Parkland 28 percent more beds when completed in 2014. Never going back After leaving Parkland's ER, Ms. Milbrodt spent a few days at home resting with her leg up. Then she put it in a brace, which she still wears. She says it seems to be healing. She doesn't have insurance, and she doesn't plan to pay Parkland. "Nothing was actually done, and every time I requested help, they told me to sit back down, that there were more important things going on," she says. Neither does she intend to return, she says. "I don't think I would go back to Parkland if I was dying," Ms. Milbrodt says. AT A GLANCE: ER ALTERNATIVES Some problems should always be treated as emergencies, such as chest pain, not being able to breathe, or severe and uncontrolled bleeding. Other times, it's hard to know whether making a trip to the ER is the right thing to do. Healthwise, a nonprofit health care information provider, suggests asking yourself this question: "Am I thinking about going to the ER because it's convenient or because it's necessary?" If you decide it's not necessary, consider these alternatives:
SOURCE: Healthwise » Post Comment
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