on the free clinics

[nadinbrzezinski]

twenty years ago as a medic I was told by patients, that they did not want the care. WHY? They had no insurance/ their insurance would not cover it.

In a few cases we went for the EMS form and had them sign the Against Medical Advise and hoped they would not be worst for it and every time I felt like crap. Didn't care if they were Mexican or American I felt I failed them. More than once I fought the good fight and managed to get these patients into an ER... most were treated and released and never handed a bill. Some were American. So watching a woman with stage four cancer that has not seen a doctor hurts, but is not shocking, not to me. Been there done that.

Seeing another with hypertension that could lead to a lethal stroke within a month, again not shocking.

Diabetics... you kid me? Our daily bread almost.

I've posted the stories here. What we are seeing in our TVs has been there, right under the surface, for many years. It is a festering problem that gets worst and worst and worst every year.

My favorite of these cases was the 19 year old who was in a crash. When we arrived on scene he was rubbing his neck... usually NOT a good thing. By protocol he should have been on backboard and in the back of my rig within ten minutes, on the way to the hospital. We "wasted" most of the golden hour (the ideal time to get trauma patients to the hospital) arguing with him why he needed to see a doctor. Oh he had tingling in the tips of his fingers... and he was having a few issues with orientation by the time we got him to the rig. (One reason we transported) and swelling and tenderness on his neck. But you see he could not afford the damn ambulance, never mind I kept explaining to him that we did not charge. In the end we took him to the trauma bay, and yes his neck had a fracture... damn lucky that it never did move... his cord was swelling up (see that tingling) and he had a bad concussion. But he could not afford the ambulance, he did not have insurance.

We called parents, and they were more or less hysterical when they got to the Red Cross. It was not just the fact that their child, lets call him bob and not his real name either. was hurt. it was the... medical evacuation to come (and the cost) and the fact that they truly believed we were going to land them with a huge bill. It was that sense of desperation that you never forget... Well in the end he was evacuated. I called the damn county ahead of them, and told them that this was a county case... and they got some assistance. But that accident cost the family a LOT of money... and I could not imagine, and have been blessed over the years, to have to decide whether to pay for the rent this month or the ALS unit and other costs.

For the record we offered to do the transfer, but for many complex reasons there was a period when we were highly discouraged from doing that. At times I think it had more to do with squeezing blood from turnips. So we did the next best thing. We took him to the border and called 9.11 saving them the triple charge of an international evacuation. And that, among many other calls, made me a fighter for single payer. I saw way too many of those patients working in a border town. Oh and don't get me wrong, most of my patient load were Mexican Citizens who were in dire straits too. The working poor share much across borders... but at least I did not have to fight them to take them to the hospital because of the cost... and yes I will say it... most people expect that to happen in Mexico, but not in the United States. Oh and taking a public health elective I remember raising the issue back in the early 1990s. One of our class mates started going over how if they did not have the money they didn't deserve the care... right up there with right wing talking points. Lets just say I had to control my impulse to deck this guy.

[Hissyspit]

1. K&R nt

[nadinbrzezinski]

2. Thanks I don't get it why at times these real stories

sink... trying to read the tea leaves though right now with Obama on the tv machine

[riderinthestorm]

3. You'll get a K & R from me but damn it all, why do these sink? nt

[nadinbrzezinski]

4. I really don't know

I guess Keith does a better job!

:-)

[EndersDame]

5. K&R

[juno jones]

6. K&R! n/t

[nadinbrzezinski]

7. thanks and I like that pirate of yours

cute one funny movie too.

[csziggy]

8. K&R

[NikolaC]

9. K&R n/t

[Lydia Leftcoast]

10. One of my former colleagues was in a car accident in Costa Rica

and was taken to the ER. They didn't admit her, but she was patched up, given some pain pills, a muscle relaxant, and crutches, and released. Total cost? $15 for the pills and crutches. She said that the hospital looked up-to-date and well-run, that she was seen quickly, and that the medical personnel were kind and considerate.

She received this treatment in Costa Rica. As a non-resident.

Having been in an accident with similar injuries in the States, I know what it would cost here: several hundred dollars for the ambulance and a couple thousand for emergency room treatment. Fortunately, the driver's auto insurance paid the bills in my case.

Ironic, isn't it? If you don't have health insurance or are under-insured and you suffer a serious injury, you'd better hope it's in a car crash, because then you have a chance of it being paid for.

[nadinbrzezinski]

11. Ironic indeed

we had to fight to keep the equipment more or less up to date... we are a charity for god sakes

And in lean times I filled the tanks of more than one ambulance for my shift to keep them on the road... but at least back then when people asked where is the billing department? We pointed to the donation box at the entrance to the ER.

Heck when I needed stitches I was going to put money in it. but the staff said, YOU NUTS? You need the money for the anti biotics...

[bobbolink]

12. I don't think this is an unusual situation. I would like to see you testifyy about this to congress!

These are stories that need to be told.

Are you a member of PHNP? I would hope that these are the stories they are collecting, although I certainly haven't heard of any such book, or project.

I did a lot of volunteer work for the local arm of the PNHP a number of years ago, and I became tired then of hearing the "sob stories". That was because people wanted to tell their stories, but when it came time to actually take action, they refused to commit. That is when I got disillusioned with peoples' motives... they cared about themselves, but not about the larger problem.

However, I think stories like this are very important, and need to have a wider audience. Is there any way you can spread this further?

I know you attribute this to a border-area, but I seriously suspect this is not that unusual in ANY area of the US, particularly any poorer areas. But I'm reasonably sure that even in affluent areas, there are still plenty of people who siply can't afford the "luxury" of emergency care!

Thanks for sharing this!

[Hekate]

13. KnR

Keep it up

Hekate