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The case of a predator in the hospital

Several years ago I was taking care of a pleasant elderly woman with a heart condition on an inpatient unit. One morning I went into her room to check on her and I found her sitting up in bed, clutching her purse and crying.

“What’s wrong, Mrs. Johnson?” I asked, perplexed.

She blew her nose in a Kleenex and replied, “Someone stole my insurance cards, my money, and my credit cards! They were in my wallet just yesterday evening – and this morning they’re gone.”

I paused for a moment, considering the order of priority in which she reported the missing items, glanced at her telemetry monitor (her rhythm was regular though her heart rate was elevated from crying), and asked if she knew how this might have happened.

She told me that she suspected that a certain patient had sneaked into her room in the middle of the night and removed the items from her wallet.

“How do you know it was that patient?” I asked, growing suspicious.

“I’ve seen her sneaking around at night in other people’s rooms – a couple of nights ago she was in here digging through my roommate’s dresser drawers.”

The suspect was a 38 year old woman with a known history of heroine abuse, who was admitted to the General Surgery service (conveniently boarded on our Internal Medicine floor) from the Emergency Department to complete an acute abdominal pain work up. This woman had already terrorized the surgical intern assigned to her case (as I had heard on rounds the day before) by chasing her around the hospital room with a hypodermic needle. Security had come to restore order and had found a stash of heroine and some needles in her bathroom that had been brought in by her visitors the night before. The team decided not to discharge her because they had discovered a large abscess on her ovary (from an advanced and untreated sexually transmitted disease) that they felt obligated to drain and treat her with antibiotics. Of course, on the morning of her scheduled surgery she ate breakfast, making it unsafe to put her under general anesthesia. These games continued (sneaking food before surgery, refusing surgery or medications, then changing her mind, then claiming to be homeless with no safe discharge plan, etc.) so that her length of stay grew from days to weeks.

“And now,” I thought to myself, “she’s using our hospital as a flop house, victimizing MY patients on the same floor – stealing their belongings in the middle of the night?!” This was the last straw. I told Mrs. Johnson that I would get to the bottom of the matter.

And so I waited for the victimizer to leave her hospital room for a scheduled test – I sneaked into her room and went through her bedside table drawers. Lo and behold, my patient’s ID and credit cards were stashed in a box with a bunch of other IDs that clearly didn’t belong to the woman.

I called hospital security, and we reviewed all the items that she had stolen. As it turned out, she was admitted to the hospital under a stolen Medicare card (the woman had claimed to be on disability). Her name matched with our records of a 67 year old woman, so we knew that she had been admitted under another’s name – and the admitting clerk had not noticed the age discrepancy. A careful record search turned up the drug user’s previous admissions under this alias. This predator had been gaming the system for years, eluding detection!

I asked the security guards to help me interview other patients on the inpatient unit to see if they had experienced anything out of the ordinary over the past few weeks. What we found was astounding. Several frail elderly patients described similar night terrors (being unable to stop the woman from going through their personal items at night) and one gentleman with advanced AIDS, who was admitted for treatment of severe pneumonia, reported that the woman had attempted to molest him in the middle of the night when she was high and in a hypersexual state.

Thanks to our investigation, many patients had their belongings returned to them (though some of their jewelry was not recovered – the woman probably sold it for heroine to her visiting dealer), and I heard that the predator was caught by the city police after choosing to leave the hospital against medical advice.

I don’t know what happened to this woman after that, and I doubt that the police were able to detain her for very long. I felt horrible for the patients who had been victimized in their ill and vulnerable states, and I wondered what kind of lasting psychological damage that this woman had inflicted upon them, especially poor Mrs. Johnson. I also felt frustrated and vulnerable – unable to really protect my hospital from future assaults. What could I do, stand in the Emergency Department each night to identify her if she chose to return? I can only imagine that this woman is still up to her old tricks at a neighboring inner city hospital near you…

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Pet food scandal has scary implications for humans

The recent death of hundreds of beloved pets was traced back to a wheat gluten factory near Shanghai, China. The wheat gluten, a thickener used in pet food, was contaminated with melamine (a chemical used in plastics, fertilizers, and flame retardants). It is believed that the melamine may have been processed or stored in the same containers used for the gluten.

How did the contaminated gluten make it into over 100 brands of US pet food? Chinese ingredients are less expensive than American ones, and so large companies purchase many plant and animal products from China to save on costs. The fact that over 100 brands were recalled speaks to the pervasiveness of Chinese agricultural products contained within American food products.

A very alarming article was published by Forbes Magazine, describing the serious quality control problems that China has been having, and America’s limited ability to screen incoming goods:

Over the past 25 years, Chinese agricultural exports to the U.S. surged nearly 20-fold to $2.26 billion last year, led by poultry products, sausage casings, shellfish, spices and apple juice.

Inspectors from the U.S. Food and Drug Administration are able to inspect only a tiny percentage of the millions of shipments that enter the U.S. each year.

Even so, shipments from China were rejected at the rate of about 200 per month this year, the largest from any country, compared to about 18 for Thailand, and 35 for Italy, also big exporters to the U.S., according to data posted on the FDA’s Web site.

Chinese products are bounced for containing pesticides, antibiotics and other potentially harmful chemicals, and false or incomplete labeling that sometimes omits the producer’s name.

The problems the [Chinese] government faces are legion. Pesticides and chemical fertilizers are used in excess to boost yields while harmful antibiotics are widely administered to control disease in seafood and livestock. Rampant industrial pollution risks introducing heavy metals into the food chain.

Farmers have used cancer-causing industrial dye Sudan Red to boost the value of their eggs and fed an asthma medication to pigs to produce leaner meat. In a case that galvanized the public’s and government’s attention, shoddy infant formula with little or no nutritional value has been blamed for causing severe malnutrition in hundreds of babies and killing at least 12.

Assuming that Forbes has not overstated the case, Americans have good cause for concern about the safety of food that includes ingredients from China – is it only a matter of time before the pet food debacle is played out in humans? I don’t know, but I’m worried. Do you know of any other credible reports about this problem? Please share!

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Healthcare barriers

I worked in a hospital that was so old that the bathroom doors in the patient rooms were not wide enough to accommodate a walker or certain kinds of wheelchairs. The hospital had resisted any upgrades, because the building codes stipulated that if any improvement was made, all of the necessary upgrades were required. The cost to fully comply with the new codes was enormous, and so in some twist of bureaucratic irony – nothing changed for decades upon decades.

One morning I entered one of my patient’s rooms to check on her. There she was, 4’11”, 85 years old, with a white bob and a thin frame, wearing nothing but a hospital gown tied only at the neck. She smiled brightly as she caught my eye. She was clutching her walker, attempting to exit her bathroom straight on. I watched her as she slowly inched towards the narrow door, bumped into it and then backed up to try again. She made several valiant efforts to get out of the bathroom, holding onto her walker for stability. (Though none of the attempts involved turning the walker sideways to fit through the door.) Trapped and befuddled she smiled at me good naturedly and concluded, “I think this hospital gown is too heavy.”

When I remember this patient, I imagine how so many people are trapped in the healthcare system that is old and poorly designed. They want to get through barriers to care, have inadequate resources, and a limited understanding of what’s actually blocking them from the help they need. If you feel that “your gown is too heavy,” I hope that Revolution Health can make things better for you… we want to empower you to understand the problem and get the help you need. Let us know how we can help!

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Medical fraud – what to look out for

I was reading a news story about how medical fraud is becoming more frequent in Australia. They attribute this to the recent transition to electronic record keeping, which makes it easier to file fraudulent claims. Although these tactics are old news in the US, I think it’s worth a little summary (from the article) here – stay on the lookout for overcharges and fraud! The best way to protect yourself is to review your bills with vigilance. It’s sad that it has come to this…

Fraudulent tactics

Supply companies:

* Upcoding of items and services where, for example, a medical supplier may deliver to the patient a manually propelled wheelchair but bill the patient’s health fund for a more expensive, motorized wheelchair, or where a routine follow-up doctor’s office visit might be billed as an initial or comprehensive visit.

* Billing for medical services or items that are in excess of the patient’s actual needs. These might include a medical supply company delivering and billing for 30 wound care kits per week for a nursing home patient who only requires one change of dressings per day, or conducting daily medical office visits when monthly office visits are adequate.

Providers:

* Duplicate claims, where a certain item or service is claimed twice. In this scheme, an exact copy of the claim need not be filed a second time. Rather, the provider usually changes part of the claim so the health insurer does not realize it is a duplicate.

* Unbundling, where bills are submitted in a fragmented fashion so as to maximize reimbursement for tests or procedures that are required to be billed together at a reduced cost.

* Kickbacks, when a healthcare provider or other person engages in an illegal kickback for the referral of a patient for healthcare services that may be paid for by Medicare.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Humorous interlude about health insurance…

I’m doing my best to prepare my weekly round up of the best of Revolution’s expert blogs… but it’s taking a little longer than usual, so here’s a funny little excerpt from a Dave Barry calendar to tide you over…

In the 1950s, medical paperwork was simple: The doctor gave you a bill. That was it. Whereas today, if you get involved with the medical care system in any way, you will spend the rest of your life wading through baffling statements from insurance companies. I speak with authority here. At some point in the past, some member of my family apparently received medical care, and now every day, rain or shine, my employer’s insurance company sends me at least one letter, comically titled, EXPLANATION OF BENEFITS. It’s covered with numbers indicating my in-network, out-of-pocket deductible; my out-of-network, nondeductible pocketable; my semi-pocketed, nonworkable, indestructible Donald Duckable, and so on. What am I supposed to DO with this information?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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