More Patients Pass on Ambulance

[VentMedic]

What do you do when a patient is obviously in need of medical care and transport to a hospital but states they can not afford it? Do you have alternative suggestions such as a clinic? Or, do you just have them sign the AMA for and say "have a nice life whatever is left of it"? It ain't your problem with the AMA form in hand.
As Costs Rise, More Patients Pass on Ambulance

http://www.emsresponder.com/article/article.jsp?id=8660&siteSection=1

Laura McVicker
The Columbian, Vancouver, Wash.


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Dec. 15--It doesn't matter the circumstances -- car crashes or chronic illnesses -- Scott Koehler often hears the same plea from patients: "I can't afford to go to the hospital."

Some patients would rather drive themselves to the hospital, hitch a ride from family or friends or skip medical attention to avoid ambulance costs, said Koehler, East County Fire and Rescue's chief.

Refusing rides

There's little that emergency responders can do once a patient refuses a ride to the hospital -- besides directing them to sign a liability waiver.

"You can't kidnap somebody in this country," Koehler said. "Even if it would be for their best interest."

Leaving patients, obviously, raises concern for area paramedics. A Clark County patient once declined transport because of costs and went into cardiac arrest on the way to the hospital, Koehler remembers. The patient died.

In just the last month, Seabrook handled two calls in which two patients refused treatment during a critical situation.

One patient suffered a seizure for unknown medical reasons, and when urged by paramedics to seek examination, refused. The patient had insurance but was still concerned about costs.

Seabrook remembers another patient suffered a reaction in the middle of the night. He declined a transport because he didn't have insurance.

 

[Bosco578]

We do our best to educate them of the risks of declining,if we feel that strong about transport we get a patch Doc to try and convince them. Other than that, they sign there life away. I will advise the pt. that our billing Dept. will arrange a payment plan.

 

[tydek07]

Run into this all the time. I just sit down and talk to the patient. Explain what could/will happen if they so chose not to come in with us. Of course I first try and explain that they may be able to set up a payment plan if they call our billing office and to not worry about money right now. In a few cases I have called the ER and have had a doctor talk to them over the phone. Some people feel that if a doctor says to come in, then it must be important and they forget about the money issue.

But at the end, its their decision and if they chose to not go in with us, thats their choice (no matter what their reasoning behind it is). Before leaving I try and convince them to at least go into their local clinic or even a walk in. Have them sign the refusal form and wish them luck.

 

[Rattletrap]

You will also find that the more rural the community that pride is a big issue to over come. Many older farmers have to be at the point of death for you to get them on your cot.

 

[VentMedic]

You will also find that the more rural the community that pride is a big issue to over come. Many older farmers have to be at the point of death for you to get them on your cot.

At least with the older farmers, their word is their word. They take full responsibility for their lives and their families know this. If they die from not being transported, the family will just say "he died the way he wanted to; still in charge".

But even for those of us that do have medical coverage, may times it does not cover the ambulance bill fully. A lot of insurances are 80/20 and 70/30. A $100K hospital bill still leaves you well over $20K in debt. I know many healthcare workers that put off going to the doctor. We recently lost a co-worker who put off having a mammogram when she knew something was wrong. She just kept saying she couldn't afford to be sick right now.

Denial and financial worries can make for some bad decisions. These people can be easily talked out of anything because that is what they want to hear.

 

[BossyCow]

You will also find that the more rural the community that pride is a big issue to over come. Many older farmers have to be at the point of death for you to get them on your cot.

ROFL.. my favorite one of these was the guy who had a shattered sternum, broken ribs and a collapsed lung. Called us two hours after the event... when we got there, he'd taken a shower, had a coupla shots of Jack to wash down some of his wife's percocet.

 

[lightsandsirens5]

You will also find that the more rural the community that pride is a big issue to over come. Many older farmers have to be at the point of death for you to get them on your cot.

You can say that again!!!

 

[EMTFL]

I really don't understand some people's theories, but some just DO NOT want to go to the hospital. Perhaps fear of not returning home?

When I was doing my clinicals for EMT, we ran a call for "trouble breathing". When we arrived on scene, the lady was coughing up blood, couldn't catch her breath, and also had slight chest pain. For some reason, she refused transport. The medic and EMT on board both begged her to go, insisting that if she didn't, things might get worse. After about 30 minutes of trying to convince her, we left, and went back to the station. About one hour later, the tone came out again; same house; same lady. At that point, she was unconscious, and I was doing CPR. Unfortunately, she never regained consciousness.

I think some people honestly just have such a fear of hospitals; or perhaps they tell themselves they'll be okay and simply get through it by staying in bed.

 

[BEorP]

Sorry to bring back a thread that had begun to fade away, but I'd love for someone to read this article and then explain to me why universal healthcare is a bad thing. It is terrible to think of someone not getting medical care because of money. But maybe that's just the Canadian in me...

 

[JPINFV]

Since you asked, and not everything in medicine is an emergency.

1. There's no such thing as a free lunch.
2. Choice.
3. Time. (How long is your wait for "elective" procedures and surgeries again? What's the quality of life for that patient waiting for that "elective" hip replacement?)
4. There's no such thing as a free lunch (I had to say that one again).
5. Personal responsibility.
6. Liberty (If the government is paying for health care via taxes, does that mean that the government should be able to ban unhealthy lifestyle choices like, say, smoking?)

That said, I like the fact that Canada has universal health care. That just means that more patient's are crossing the border into the US to get that "elective" surgery that their home country won't/can't provide.

 

[MSDeltaFlt]

Also bear in mind that hospitals have ways of working with you in order of affording your health care. Where or not a pt can afford going to the hospital might not actually be our problem. Let them know that if they can't get them the financial help they need, then they can get the pt in contact with the right people to get the help they need.

Now that's on a true emergency. But I believe that most can go to clinic for their problems. On the few cases that are true emergencies, if your pt is an adult, C-A-O x 4 and verbally appropriate AND can quote back to you the possible ramifications of refusing care, then you cannot transport them.

BTW, Vent, what are the actual stats on the number of 911 calls that were true emergencies?

 

[Veneficus]

I know all the anti socialized healthcare people always sight Canada, but what about Britian, France, or Denmark?

What about having socialized healthcare with a parellel private pay system for those that can afford better?

You are already paying for socialized healthcare in an extremely inefficent way.

 

[JPINFV]

Yep, the United Kingdom has a great system.

Seven million patients can't find a dentist on the NHS for two years
...
It cited the case of a low-income pensioner given emergency dental treatment in a hospital in North Yorkshire then told to get further treatment from one of two local NHS dentists - both of whom have 12-month waiting lists.

http://www.dailymail.co.uk/news/article-508496/Seven-million-patients-dentist-NHS-years.html

Dentists refuse to treat bad teeth
DENTISTS on the National Health Service are turning away people with bad teeth because they say they are only paid enough to treat patients with a good dental health record.

One surgery admitted that people who have not had a dental appointment for three years will be refused treatment. Others are employing more subtle methods to reject patients.

Dentists’ leaders say the NHS dental contract, introduced in April last year, has had a perverse effect because dentists earn the same for giving a patient one filling or 10.

http://www.timesonline.co.uk/tol/life_and_style/health/article1845202.ece


There's another UK dentist story that I can't find right now where dentists were refusing to see patients after they met their patient quota.

Socialized medicine isn't all bad, but I'm seriously getting tired of people acting like socialized health care is some sort of panacea for the health care system.

 

[Veneficus]

Yep, the United Kingdom has a great system.



http://www.dailymail.co.uk/news/article-508496/Seven-million-patients-dentist-NHS-years.html



http://www.timesonline.co.uk/tol/life_and_style/health/article1845202.ece


There's another UK dentist story that I can't find right now where dentists were refusing to see patients after they met their patient quota.

Socialized medicine isn't all bad, but I'm seriously getting tired of people acting like socialized health care is some sort of panacea for the health care system.

What is the state of charity dental care in the US?

I agree it is not a panacea, but it is considerably better than what we have now

 

[JPINFV]

Since when did the government become a charity?

 

[ffemt8978]

Since when did the government become a charity?

When FDR came out with the New Deal....

 

[Veneficus]

Since when did the government become a charity?

They seem to have no shortage of cash to charity out to wall street and failing automakers, but can't seem to cover 100% of a bill submitted to medicare/medicade.

 

[Tincanfireman]

do you just have them sign the AMA for and say "have a nice life whatever is left of it"?

These are the cases that I haul out all the tact and diplomacy I can muster. Sometimes they go when they begin to understand that we do care about them, sometimes if we get a family member involved (curiously, this often works better with family members other than the persons S.O.), and sometimes telling them that we don't accept money and we will bill them later (you'd be surprised, especially with the older population!). If it finally comes down to it we will leave, but I want to be able to go to sleep knowing I gave it a good try before leaving the home with an AMA form)