Are government entities required to pay the hospital bills of incarcerated prisoners? This is a scenario that happens quite often. Jailed patients are admitted onto the hospitalist service through the ER for anything from patients faking seizures in the ER to chest pain to drug overdoses. When patients are under the custody of the city, state or federal system, those entities are required to pay for necessary acute health care services. I don’t know, maybe it has something to do with a prisoner’s constitutional right. You lose your right to vote, but not to get a liver transplant.
So what happens? Jailed patients get admitted and guards, sometimes, one, two or three at a time, are required to be at the patient’s bedside 24 hours a day. If the patient needs to transport to the radiology department, sometimes this must be arranged with the guards ahead of time to allow extra staffing for the transport.
As you can tell, having a jailed patient is expensive, not only for the cost of the incurred hospital expenses but also the extra labor costs of having additional guards in the patient’s room 24 hours a day. So what’s a city to do? I’ve had patients released from custody just before they were to have a major operation, just so the government could avoid the catastrophic health care bills associated with continued custody.
In the case of Princess Greatness, you have the police wheel and deal with the DA to drop the $10,000 bail to $500 and have Jimmie the Pimp bail your butt out so you can leave the hospital against medical advice.
And that’s how the city plays the game. And we, as doctors and nurses, are just along for the ride. Now, the real question is, will the city insurance pay if she leaves AMA? The answer is yes, they will, although a managed Medicaid company has dropped to new lows in the battle for trying not to pay for work provided. I had a patient on two intravenous medications requiring continuous monitoring for toxicity and the patient left AMA. The Managed Medicaid insurance company said they would only approve the patient for observation status because the patient was in the hospital less than 24 hours. What a disgrace.
Even with these games, Medicaid is bankrupt and there is nothing we can do to stop the road to ruin. Oh yeah, and I’ve had two more recent experiences where transferring a patient to the VA was an exercise in futility. You can watch my Hospitalist vs VA Xtranormal experience here.
I think the ACLU should sue the VA system for failing to provide the service they promised when our men and women signed the contract to join the military. I know they recently filed a lawsuit in Los Angeles. They should know the problem runs much deeper. If you’re listening ACLU, know that the VA routinely obstructs the delivery of necessary medical care for our veteran men and women by refusing to accept their patients into the hospital from surrounding communities. The VA is not fulfilling their promise of providing care for our military men and men. They routinely set up obstructionist road blocks and won’t accept their patients in a timely manner and they won’t pay community hospitals and doctors for providing the care for them.
*This blog post was originally published at The Happy Hospitalist*