On July 23, 2010, I woke up at around 4am with severe lower abdominal pain, vomiting and diarrhea. It was the fifth day of my menstrual cycle; and, at first, I believed it was an unexpected and, rather vicious return of menstrual cramps. Bleeding significantly heavier than usual for that late in my period, I figured my hormones must have been a out of whack.
After an hour or so of writhing, chills, diarrhea, hot flashes and not being able to keep down anything (including ibuprofen), it became apparent that these were no menstrual cramps. The pain was about five times more intense than any cramps I ever had before. Also, my menstrual cramps tend to have a certain pattern. Emanating mostly from the lower spine and radiating into the hip joints, they start low and grow in intensity, hang on for a bit, then drop out. The pain rises and falls like that in waves.
On that rough morning, although the lower abdominal pain I experienced did come and go, when it peaked at a high intensity, it held on for longer, while the drops and breaks were very brief. Also, it did not seem to have much of a connection to my spine. And, not to be gross, but one could not ignore the puking out of one’s guts and what was coming out the other end. That had nothing to do with my period.
As a person without health insurance, I fought seeking help for about three hours, knowing that a visit to the emergency room could devastate me financially. By 7am, there was no sign of it letting up. I realized I was becoming weak and delirious. After practically crawling to my neighbor’s back door, he drove me to the closest hospital in Marina del Rey.
The biggest fear was that my appendix was rupturing. At first, I couldn’t get beyond the financial cost of surgery and that I absolutely could not afford it. After four hours of excruciating pain, I couldn’t get past the idea that I might die.
By the time we got to the emergency room, I could hardly walk. I collapsed on the floor in front of the admitting desk. The nurse implored me to get up because the floor was unsanitary, which I would have been happy to do, except my stomach muscles would not unclench.
“You need to sign some forms so we can get you medicine that will make the pain go away,” she informed me rather like I was hearing impaired, waving the clip board for visual emphasis. “We cannot help you, until you fill out your paperwork.”
A different nurse lifted me off the floor and into chair. I was then presented with a number of admitting documents. I can’t recall exactly how many forms I signed, but there were at least five, maybe seven or eight. I tried to read what I was signing, but could not retain any of the information, the pain was so intense. To be honest, I might have signed my brother into white slavery for all I knew. There were moments I truly believed that something inside me had exploded and I was about to die. My hands were so shaky, my signature looked little better than the illiterate X.
Now, say you were a wealthy businessman entering into an agreement with a supplier or a young couple considering buying property – if someone tied you to a chair and held a gun to your head to make you sign a contract, that contract would later be determined to have no legal standing. If a person stuck a hot poker into your lower abdomen until you signed a promissory note agreeing to pay $10,000, they would be charged, and hopefully, arrested for felony extortion, assault, kidnapping and even attempted murder. Suing you for breach of contract would not be an option.
Yet, you can find yourself in a hospital emergency room in unbearable pain, or afraid for your life, and they will hold vital medical assistance at bay until you agree to pay (what are to most Americans) exorbitant fees. These types of contracts are somehow legal, even though a patient has no idea of the cost until after services have been rendered. It is tantamount to entering into an agreement under extreme duress and, generally, contracts entered into under extreme duress are, under the law, null and void. Not to give people “bad” ideas, but I think there could be a legitimate legal challenge to hospital fees based on this premise.
Unfortunately, in July of 2010 as is the case now, there remains little recourse for the uninsured and sick, who are left in terrible debt after an unexpected visit to a healthcare facility.
After all the signing of my life away was complete, I was admitted and assigned a bed. Still writhing in pain and hyperventilating, the nurse asked me to slow my breath and calm down so she could get my vitals and start the IV. She soon administered a drug to prevent nausea, which was a prerequisite to the pain medication. “The morphine sometimes makes people sick to their stomach,” the nurse offered up pretty much the only explanation I would receive all day for what was happening to me.
Five agonizing minutes later, she came back with a small vial and a syringe. Even though the pain was not immediately effected, as she filled the syringe and shot it into the IV, my body relaxed from the stress, in anticipation of relief. Unfortunately, fifteen minutes beyond that, relief had not arrived. Another pain medicine was administered, which took the edge off, though I continued experiencing some pretty intense waves.
After I relaxed enough to hold still, the attending physician, got involved. He asked me a few questions and performed a lower abdominal and pelvic exam. He felt around and kept asking me where it hurt, rolling his eyes when I couldn’t quite tell him. The truth was, it hurt all over. In the hope of getting his damn fingers out of my abnormally bleeding uterus, I told him that I thought the pain was worse on the left. Because of this, he eliminated appendicitis and ordered a sonogram. This would be the only time he would seek my input for the rest of the day.
He moved on to other patients. The nurse returned, wanting to know if I was still in pain. The answer was pretty obvious. She administered the final dose of the medication that I had previously received. About five minutes later, nearly five hours since the pain had begun (and almost two hours since I had arrived at the hospital), I experienced some relief. At that point, with the intensity diminished, I could tell the pain was, indeed, originating from my left side, probably the ovary. Since the doctor was long gone, there was really no one to tell.
Other than the sonogram, never once did the attending discuss with me what tests he had ordered, of which there turned out to be several. In all cases, including the sonogram, no one ever explained the reason for the tests. No one ever discussed with me the cost of those tests, or, sought my permission to administer any of those tests, when I was in a calm state and capable of making rational decisions. But why should they? When I entered the hospital, I had – carte blanche – signed my rights away. When I was terrified, in extreme pain and nearly incapacitated, I had agreed to let them do whatever the hell they wanted for as long as I stayed.
I later discovered they ran a CT scan to check for a kidney stone. After the scan, the attending popped in to congratulate me on not having one of those nasty crystallized little beasts. Well, hell yeah, I didn’t have a kidney stone. I could’ve told him that. I know my body pretty well. There had been no trouble urinating nor did the pain increase upon urination. There was also no blood in my urine. Had someone explained to me the reason for the CT scan, I would have said, “Why don’t we save a few thousand bucks and skip that one?”
In the afternoon, following X-rays, blood work and cursory observations, I was discharged without a diagnosis. I suspect, from a previous ER experience in Chicago (years ago, when I had been among the insured), that I had a severely inflamed ovarian cyst. By the time the sonogram was performed at Marina del Rey, there was no clear evidence. The cyst had presumably ruptured, though the sonogram report did show excess fluid present around the ovary.
From Marina del Rey Hospital, I departed knowing virtually nothing more about what had gone wrong with my body than when I had been admitted. Well, unless you count the attending showing his face a third and final time to say so long and “…uh, maybe you just had bad cramps.” If I hadn’t been so weak from the pain and vomiting, I would’ve stood up and punched him in the testicles.
Before my ordeal could end, I had to sit down with a billing rep. I was presented with charges of $400 for the doctor and $900 for the emergency room visit. She explained that these were special cash rates, only applicable if I could settle right away. She especially emphasized that I should pay the $900 hospital fee, saying that if they bill me after the five day grace period, it will be for “a lot more.” As for the $400 doctor fee, she said that it might be a little more when they billed me later, “but not much; and, it is sometimes less.”
In 2008, I had filed bankruptcy after not being able to find work for almost a year. By 2009, I had started a pet-sitting business. My adjusted gross income was somewhere around $15,000 which was up from previous years. In 2010, I probably made around $20,000. In short, I was a woman with no savings, no credit and no insurance, trying to build a business all by herself in a high cost of living urban environment. Coming up with $1,300 in five days was a daunting task to say the least.
Per the billing rep’s advice, I focused on the $900. As you will soon see, THANK GOD I DID!! From multiple resources, including parents, a very generous client and a newly opened credit card, I pulled it together and paid that portion of my fee, with the understanding that I would be billed by the doctor at a later date for an amount around $400. As far as everything else, we were all settled. That wasn’t quite the case…
A few days later, I received a $758 radiology bill (for X-rays the reason of which was never explained to me). I called the billing rep who had previously assured me the $900 covered everything sans the doctor. She said she had been talking about the hospital fee. Radiology was a separate entity. She reminded me that I had signed a form where this was explained. Oh sure, I remember that, when I was blinded by pain and couldn’t actually read or speak English. But hey, that’s neither here nor there.
Knowing I had no choice but to pay (because within the American Healthcare system, contracts entered into under extreme psychological stress, even torture, are legal), I called the good people in radiology to work out a payment plan. I told them I had no insurance. That’s when they give me the MediCAL rate of $189. Given the reduced amount wasn’t due for another thirty days, that was probably doable. Hopefully the doctor bill was all that was left.
When I received the physician’s statement, the attending had decided to bill me for an EXTENDED EXAM. Undiagnosed, six minutes total with a patient; and that qualifies for an extended exam. Also, he slapped on a night charge of $94, even though I was admitted at 7am and discharged at 1pm. This brought his total bill to $604. That’s a tad more than $400, but I would soon discover that it could’ve been MUCH worse.
In a few days, I would receive yet another bill, a statement for $9,504. There was an acknowledgement of $900 received, so at that point I only owed $8,604. Lucky me. Perusing the itemized list of services and costs, the utter ludicrousness of it all was overwhelming. I was charged $1,052 just for walking into the emergency room door. The wonderful unnecessary CT scan totaled…yes…wait for it…wait for it…$5,256. That test alone was over half my bill.
Fortunately, this time when I called the hospital billing administrator, she informed me that the computer had simply not crossed all its t’s and dotted all it’s i’s yet. The invoice was mistakenly generated. I could relax because, as far as the hospital was concerned, I was paid in full. But, if I hadn’t paid the $900 within five days of being released, I would’ve, in fact, been responsible for 900% more in charges. I think she could’ve made it a little more clear how important it was to get the funds together for the special cash rate – like turning tricks, selling your first born child important.
The remaining question is what happens to all those charges that I didn’t pay. Do we think that the hospital (out of the kindness of its heart), just dropped the remaining $8,604, because I was so prompt in forking over a mere 10% of what was owed? I’m sure they took off a few hundred, maybe even a couple of grand; but for the most part, that $900 had been my MediCAL deductible. The rest of my bill (including the unnecessary CT scan) had been footed by the good tax payers of the State of California. No wonder MediCAL funding is being cut and in danger of completely disappearing. My God, the waste…
Whether or not you believe the government should be involved in the running and management of healthcare, I think we can all agree that the government should protect its citizens from entering into a binding contract when they are so incapacitated, they cannot act as their own advocates. Doctors should actually talk to their patients about what is going on, so a patient can make informed decisions about his or her healthcare and subsequent healthcare costs. Also, I am willing to accept that, perhaps, we’ve been too sue happy with monetary awards getting out of control in malpractice cases. This creates an environment of fear, where a hospital tests you for everything and the kitchen sink to avoid a lawsuit. We need to get those fear driven decisions out of the system.
Make no mistake; however, it is insurance companies that dictate so many healthcare choices in this country – not doctors, not patients. That is your biggest problem. Doctors have to consider cost and what measures insurance companies will ultimately cover, when they make life saving decisions. If doctors know a patient is uninsured and the money is not there, that patient may never get the answers he or she needs.
On that note, I had a followup exam at a FREE CLINIC a few days after my ordeal at Marina del Rey. The wonderful and sensitive physician at the Westside Family Clinic, went over the tests that had been administered at the emergency room. She said I had both a white cell count and potassium count that were alarmingly low. She said the attending should have been concerned about indicators of a serious infection and discussed the results with me, emphasizing the need for follow up care. The attending, at the Marina del Rey ER, did not do that at any time during his “extended” exam.
I don’t want to go on a political attack, but why is it that the GOP thinks healthcare reform is unnecessary? Why are they determined to destroy “Obamacare” (arguably, flawed legislation) and offer up no viable alternative plan, so that most people in this country have access to adequate and affordable healthcare? Have we really gotten to a place where the poor and lower middle class can just drop dead?
Having said that, a year and a half later, I am yet in awe of my family and community and how they were there for me. I came home from the hospital that day to find my fridge filled with fresh fruit. Friends called all day to check on me. A buddy picked me up from the hospital, while he was on a date. One of my clients gave me a gift of $500, because she knew I was in trouble.
Isn’t that really, at the end of the day, how we get through? We survive on the strength of our community. We rely on friends, family and co-workers to step up with the needed support. Sadly, the unfortunate state of the Healthcare System in this country, is placing intolerable burdens on those bonds. I am afraid that, no matter how much we hunker down with those we love, it may not be enough to overcome a fatally flawed system.
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