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"Allstate-itis"

This (hat tip to KevinMD) is one of the worst cases of attempted personal injury fraud that I’ve heard of:

It was a very busy weekend afternoon in the ED when a city bus accident occurred. What a disaster. Rarely is anyone really injured but everyone on board almost always winds up coming into the ED. The city encourages it so things can be documented and people are like “Cha-Ching!”, lawsuit! So, this particular time, about 5 people were brought in on back boards (we were lucky to get so few!)  As the 3rd year resident started interviewing them one at a time (since all were stable and ambulatory (walking) at the scene), one of the patients said, “Hey Doc, that guy over there was not even on the bus at the time of the accident! He jumped on board afterwards and started complaining of back and neck pain!” The resident could have gone over and confronted him angrily (who would blame him) but instead chose a different approach. He calmly went through all the other backboarded patients, clearing them all clinically out of their cervical collars. He simply ignored the man suffering from “Allstate-itis”. The funny thing is that 2 hours went by and everyone just ignored him (although I think he was triaged at some point – damn EMTALA). All manner of stuff was going on around him. His stretcher was parked right next to the nursing station yet it was like he did not exist! Finally, the guy called the resident over and said, “Hey Doc, isn’t someone going to check me out and do x-rays?” He replied, “Well, you weren’t even on the bus so in my mind, you are already checked out!” Knowing the jig was up, the man sat up, took his C-collar off, and left the ER. I guess he was thinking, “Oh well, maybe next time I’ll hit the jackpot!”

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

Thin workers woo investors?

I had an eye-opening conversation with Dr. Jim Hill
today.  He told me that Denver’s
Metro Mayors (Denver’s
metropolitan area is actually composed of 37 cities and towns!) are competing
with one another to see who can get their inhabitants the most fit and thin.

Why would they be so aggressive about fitness and good
health?  Because they say that large
corporations considering investing in Denver
(where they’d build factories or large office buildings) know that setting up
shop in areas where the population has a lower BMI means that health insurance
costs will be lower.

That’s right my friends.
Being thin can lure investors!  It
makes sense that a corporation seeking to avoid the skyrocketing costs of health
care would want to create facilities where new employees are likely to have
fewer medical issues.  And BMI is a good
surrogate marker for health… so there you have it.

Do you see this approach to wooing investors as a form of discrimination
or just good business sense?

Either way, I’m going to get on the treadmill later.

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

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.

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.

A tale of two car accidents

A few years ago I was walking home from the hospital after a long shift, when I witnessed a bicycle messenger struck by a taxi cab. The cyclist was riding at high speed across a crowded intersection and the cabbie was accelerating through a stale yellow light. THUD. The man flew across the pavement, the cabbie screeched to a halt, horns honked, a crowd gathered… I ran up to the man to check him out. His right shin was bleeding (he was wearing shorts), but I didn’t see any obvious deformities or broken bones.

The man was panting, his adrenaline pumping. I asked him to stay down for a moment while I checked him out. “F-off,” he snarled, “I don’t need your help.” Since I saw him fall, I knew that he hadn’t sustained a head injury that could explain his potential disorientation and poor decision making. I called 911 on my cell phone and gave them the scene coordinates while I tried to get the man to agree to get checked out. “I don’t need a f-ing ambulance, don’t call them!” he screamed, blood dripping down his leg. I did my best to reassure him, but he was adamant. He got up and started limping towards his bike (which, quite miraculously, was not bent out of shape from the blow). I continued to plead with him to just wait a moment to let the paramedics take a look at him, but he would not be detained. Short of using brute force to keep him down, there was nothing I could do. Distant sirens sounded, he hopped on his bike, muttered “I don’t have insurance” under his breath, and rode off. The taxi driver appeared extremely relieved. The crowd dispersed, the taxi left the scene.

When the fire truck arrived, I explained the situation. They asked which direction he’d driven off in, and they pursued. I don’t know if they ever found him, but catching a cyclist with a fire truck on the crowded streets of Manhattan is unlikely.

——–

A few weeks ago I was walking down a narrow street in DC. An ambulance was parked in the middle of the street, a small SUV was in front of it, and a middle aged woman in a dark suit was sitting on the asphalt appearing angry but unharmed. I heard from an onlooker that she had darted out behind the SUV while it was moving slowly in reverse. She had been struck lightly, but was speaking loudly about suing the driver, and was demanding that she be taken to the ER for a full check up. The EMS team interviewing her was hesitant to put her on a stretcher since it was so obvious that she could walk. The woman was refusing to get up, and they were trying to figure out how best to carry her.

I gritted my teeth and walked away, wondering what kind of legal torture the SUV driver was in for.

These two car accidents left an impression on me – the uninsured will go to extremes to avoid costly medical care, while the personal injury lawyers rack up serious cash on trumped up claims. What’s the point of this post? I guess it’s a reminder to look both ways before you cross the street, drive carefully to avoid pedestrians, and make health insurance a priority!

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

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