Monday, October 13, 2014

Money, Class and Ebola

An adult patient in extreme pain, spiking a 103-degree fever of unknown origin, gets discharged from a Texas hospital emergency room for one reason, and one reason only: no health insurance. It wasn't rank medical incompetence or missed communications among an overworked staff that sent a critically ill Thomas Eric Duncan out the door. It was, very likely, unwritten hospital policy. No card, no money, no extended service beyond the minimum legal requirements: I can almost guarantee it. A study by the Academy of Emergency Medicine, relying on data from over 80,000 patient visits to a large university medical center, reveals that insured patients are admitted to medical floors more often than the uninsured, for the same complaints and conditions.

This initial refusal of admission is likely what caused Duncan and his family to try to tough it out for days until, in desperation, they called an ambulance. By then, he was probably beyond help.

American politicians love to boast that "we" have the greatest health care system in the entire world, well-equipped to handle Ebola cases. This cavalier statement got a well-deserved jolt when a nurse treating Duncan came down with the virus herself over the weekend, despite the vaunted precautions. It is assumed that she has health insurance from the hospital employing her. In any case, she was immediately admitted. Why she wasn't flown to one of the centers with expertise in treating Ebola -- as was an NBC cameraman and others who contracted the disease in Africa -- isn't known.

Meanwhile, there are millions of homegrown Thomas Eric Duncans out there, uninsured or underinsured, who each and every day are absolutely hesitating to seek medical help if they start feeling sick. One little trip to the emergency room is enough to bankrupt anyone -- whether they're covered under Obamacare or not. According to a new study by the personal finance site NerdWallet, more Americans are going broke from medical bills than ever before.

We can't afford to get treatment for our diseases.

The bean-counters at Texas Presbyterian likely knew that it would have been next to impossible to get Thomas Eric Duncan into collections once he was successfully treated and left the area or went back to Liberia. As a foreigner, he wouldn't have qualified for expanded Medicaid coverage even if Texas had accepted the coverage.

It's getting hard out there for for-profit health care systems to extract money from their strapped domestic customers:
  • NerdWallet Health has found that Americans pay three times more in third-party collections of medical debt each year than they pay for bank and credit card debt combined. In 2014, roughly one in five American adults will be contacted by a debt collection agency about medical bills, but they may be overpaying – NerdWallet found rampant hospital billing errors resulting in overcharges of up to 26%.
  • NerdWallet found 63% of American adults indicate they have received medical bills that cost more than they expected. At the same time, 73% of consumers agree they could make better health decisions if they knew the cost of medical care before receiving it.
  • Between 2010 and 2013, American households lost $2,300 in median income, but their health care expenses increased by $1,814.[1] Out-of-pocket spending is expected to accelerate to a 5.5% annual growth rate by 2023 – double the growth of real GDP.
(graphic: NerdWallet)
Because of its cruel social policies, America is a fertile breeding-ground for disease outbreaks. Since we don't have universal health care, we think twice about seeing a doctor. We don't have federal mandatory paid sick leave-- the 40 million American workers who don't enjoy even one single paid sick day are mainly employed in the low-wage food service and child care fields. We're taught to tough it out, to slog into work with our sniffles, low-grade fevers and hacking coughs. We spread our germs to our restaurant patrons, our supermarket customers, our classrooms full of kids. Too many sick days, too often spent staying home to care for sick kids, and we might be out of a job. There are too many unemployed people out there waiting in line, ready to take our jobs if we let a few symptoms get in the way of progress.

And despite their sanitized gated communities, security guards, private schools and concierge medical services, rich people are not immune. They interact with us whether they realize it or not. They sleep on sheets laundered by others, eat food prepared by others, breathe the same air as everybody else.

Conversely, the rich are also fully capable of transmitting disease to the poor. Celebrity NBC medical reporter Nancy Snyderman, M.D. was caught getting takeout at the ironically named Peasant Grill in Hopewell, New Jersey last week when she should have been in home quarantine, having been exposed to Ebola in Liberia with the rest of her news crew. Naughty Nancy, ironically named by Readers Digest as the 30th most trusted person in America, was busted by the health police and sent back into isolation. So it seems that the rules do occasionally apply to the elites too, especially when they threaten to sicken other elites. It's the affinity fraud, Bernie Madoff type of crime. When the wealthy become victims of the wealthy, justice prevails.

The plutocrats running this show had better get with the program: selfishness and greed are hazardous to their health, too. Social Darwinism is a pathology deadlier than any plague.

"I don’t know about you, but I like it here. Sure, life can get complicated, hard to get through, and it’s not always fun, but I don’t want to be shown the door anytime soon. If there are ways I can enhance my health and longevity with healthy habits, if there are appropriate screening measures for my age group, if there are new lifesaving treatments I can access, then I want to know about them so that I can stay around and be kicking up my heels when I’m ninety." -- Nancy Snyderman, on Why It's All About Nancy.


Healthy, Wealthy and Snyde(rman)

 

33 comments:

Bill Neil said...

Courageous piece, Karen. I think you are right on the Dallas dynamics.

From personal experience, without health insurance, one stays away from emergency visits and even check ups. No one, the individual or the society, wins from that ugly reality.

This would make a good NY Times guest op-ed. Worth a try because you're filling in both the editorial gaps and the coverage gaps. Of course the odds are...

annenigma said...

As a retired public health nurse in the area of infectious disease control and prevention, I respectfully beg to differ.

The doctor ran lab tests and did an abdominal CT scan and chest xray on the patient. Based on the results, he could not definitively diagnose him because the only sign he had to base a diagnosis was on the fever. Labs didn't provide any insight neither did the imaging. The doctor correctly assumed an infection of some kind and played it safe, if not wise, by treating it as a bacterial infection and prescribed antibiotics. What other tests could/should have been done? Maybe he could have hospitalized him for observation but he wasn't elderly or a baby, the highest risk patients. Many hospitals are pretty full with few, if any, beds available. They can't and don't admit everyone.

The doctor did his due diligence in terms of tests. I doubt he was even personally aware of the patient's insurance status while working in a busy ER. Furthermore, if the issue was lack of insurance, the doctor could have easily just written the prescription for antibiotics without ordering any tests and sent him home. Plenty of doctors already do that routinely to save time and money for the patient, for themselves, and for Medicare if they don't expect reimbursement. They just don't bother. That was certainly an option for this doctor.

No, the doctor missed the proper diagnosis because an uncommon infectious disease was not in his routine medical repertoire. Two sayings come to mind. The first is: 'See what you look for and look for what you know'. The doctor had never seen Ebola and being in the usual assembly line mode as most doctors are, it never even crossed his mind.

I see no evidence to support the claim that the patient was sent home primarily because he lacked insurance. I do see evidence that the doctor discharged him AFTER doing a battery of appropriate TESTS which DID NOT reveal a source for his infection. It was simply a judgment call that he got dead wrong. That actually happens a lot every day, everywhere.

That brings me to the second saying: 'Doctors treat to the test'. I believe that that was the real case here and not an insurance decision at all. The doctor was focused on test results and not his own independent judgment. Was he even aware of the patient's insurance status? Maybe a doctor in private practice, but in an ER? I seriously doubt it.

I would add one more thing - the dumbing down of America and I would include some doctors in that category. Too many don't bother learning anything new other than in their own narrow, specialized field of medical practice (and maybe also investments). Americans in general are not interested in education unless it's related to making money and their own careers. Knowledge for its own sake is passe.

Where is Liberia anyway? Kansas? Americans barely follow any news at all and certainly not international. Do they know how many countries Obama has bombed? (Seven!). Don't upset any Americans with disturbing news of any kind because you might make them feel bad.

Pearl said...

Facing opposition, Obama slows push for surgeon general http://usat.ly/1iOfiEe via @usatoday

Why we don't have a Surgeon General appointed to be in charge of this latest health care crisis as well as giant cut backs to health care personnel and funding for the last 5 years.

annenigma said...

One more thing. Doctors don't tend to read what gets sent to them, whether it be something important in the patient's chart (such as travel to Liberia) or warnings and advice from the CDC. Everything has to be kept short and directly relevant to them and their own practice (or to their families) and has to be dropped in their lap, otherwise they're not likely to even give it a glance. That's been my experience anyway.

Pearl said...

An Update on State Budget Cuts — Center on Budget and Policy Priorities http://www.cbpp.org/cms/?fa=view&id=1214#.VDwKYWQDWHc.twitter

Karen Garcia said...

Anne,

Having been an E.R. patient without insurance myself on a few occasions, and having known others in the same situation, I can assure you that doctors do indeed routinely question people about their insurance as part of the patient intake. This is not because the docs themselves are afraid of not getting paid -- they and the nurses are very good people, concerned that the patient will be bankrupted if they "err on the side of caution" and admit or over-test. Most doctors and nurses realize that the anxiety of not being able to pay a humongous hospital bill is itself an impediment to recovery. Not all test results are immediately available to ER staff, esp. in smaller community hospitals. So what Duncan got was CYA medicine.

The last time I was in the ER, the hospital couldn't verify my insurance on their computer, and while I was being examined by the physician, a lady with a clipboard was right on the other side of my bed, having me sign all kinds of promissory papers, in triplicate. And the doctor himself asked what my insurance did and didn't cover. He was very hesitant to order a CT-scan, for example, because of the high cost.

Give me evidence that this particular Texas hospital suffered from a severe overcrowding problem, and I'll be happy revisit my hypothesis.

Karen Garcia said...

Bill,

Yes, the politicians boast that medical spending is down, but forget to mention that it's because people have no money to spend on medical care. Their cruelty, stupidity and corruption boggles the mind.

Pearl said...

Funding cuts delayed Ebola vaccine, U.S. official says http://ti.me/1wssWz1 via @TIMEHealth

Isaiah Earhart said...

Great piece Karen.

As to the lowering of medical costs for individual, I can personally attest to the truth of that claim.

About 7 years ago, I went to the dentist to get a filling for my tooth. The dentist's office called me three weeks after the proceedure to tell me that I owed them $300 more because my insurance company refused to cover the type of metal they put in my mouth. I am not kidding. I told them that I was not given a choice about the metal they put in my mouth, but that seemed to matter not to them. I went and paid the $300 after my next payday.

My medical expenditures since then: $0.

So I got that going for me!

Bill Neil said...

Annenigma:

I offer this recent 10/10 Wall Street Journal Account which does not go into what tests were or were not run, but does emphasize that the hospital had been repeatedly informed to be on the look out for Ebola and patients seeking treatment who had just returned from Africa, much less Liberia and the capital.

http://online.wsj.com/articles/liberians-last-days-in-dallas-with-ebola-come-into-focus-1412983466

In fact, an authority is quoted in the article as saying that Emergency Room 101 protocol on travel questions was violated...

Having been married to an E-R doc, I don't want to be too hard on their very, very difficult job, but I do think that the Ebola story was so much in the news in the past two months before this tragic incident and I find it very hard to imagine it not being on the minds of medical personnel doctors, nurses and et al, and the first responders. It's always possible it wasn't but then you have two or even three layers of oversight in this case: warnings sent directly to the hospital, the background news coverage and the medical history of the patient, which was not hidden apparently.

Whether Karen's hypothesis operated in the background is going to be very hard to prove, but has to be their as a possibility.

In that matter, let me say from my own personal experience in running up 30,000 dollars or so in unpaid medical bills due to heart problems over the past four months, without health coverage at the age of 64 for these procedures and costs, the very first questions I was asked when I did make my initial cardiology outreach was did I have coverage, and I was told, before I ever saw a doc, to report to the billing room. In fairness, I was not turned away and the collection agencies have not yet descended, and I have had very generous bill forgiveness from the hospital, and I was upfront about my ability to pay and at what rate, both parties knowing that short of winning the lottery I would never be able to pay it all back in my one lifetime here on earth.
But in every outreach I did then to the doctors or the hospitals, the first concern is about my coverage, how would I pay.

I am having trouble squaring the account of this doctor and all the right tests he ran, but he was unaware of all the background noise and alarm of this infamous disease outbreak? All these warnings aside, wouldn't there have been the language and accent clue in speaking with the patient; I understand from this article that his hoped for bride did the interpreting: again a direct clue that a traveler from Africa with a 103 degree fever needed very special care.

annenigma said...

Every health department in the country has received federal funding over the past decade for bioterrorism/emergency preparedness and response (while funds for CDC have been cut), but that money doesn't go into the infectious disease control division in those counties. It is separately funded and staffed because it is related to bioterrorism. I believe they work with Homeland Security or FEMA rather than CDC.

Ebola is interesting because it has now broken out as a natural disease but it is also listed as a High Priority disease agent related to bioterrorism. So these teams have been training for exactly this kind of disease but probably won't be assisting because it didn't arrive by terrorist. If it had, there would be a level red alert and all hands on deck.

Since their mission is emergency preparedness and response, they must surely have the latest and greatest personal protective equipment (PPE) and gear stowed away somewhere. I wonder if they'll keep it for themselves or distribute it to the nurses and doctors ahead of time so they can train. Or maybe they'll wait until there's an actual diagnosed case in their area and people are fighting each other for PPEs.

Nurses should be demanding the same equipment and training that Doctors Without Borders get. Too bad CDC got squeezed out of the disease response business by the warriors in Washington who control the purse strings.

Denis Neville said...

“The real elephant in the room is, the man was black, he had no insurance, and therefore he was basically turned away. If he had pulled out an insurance card, he wouldn’t have had a problem. I’m willing to stake my life on the fact he didn’t have insurance. He’s from Liberia! They did what they traditionally do: They gave him some pills and sent him on his way, basically ignoring all the CDC protocols. If you’re of color and present without insurance - they’re not going to call it ‘dumping,’ but in the final analysis, that’s basically what they did.” - John Wiley Price, Dallas County Commissioner

http://www.latimes.com/nation/la-na-family-questions-care-given-texas-ebola-patient-20141008-story.html

It happens every day. Today’s realities of the actual practice and economics of acute care by hospitals, i.e., our broken health care system.

Texas Health Presbyterian Hospital of Dallas doesn’t normally serve indigent patients. It is privately owned, not a charity hospital. It is a “very profitable” part of a not-for-profit healthcare conglomerate, Texas Health Resources.

http://www.dmagazine.com/publications/d-ceo/2013/november/texas-health-resources-and-baylor-health-ahead-of-curve

Texas Governor Rick Perry and the Texas Legislature refused to establish a Texas Health Insurance Exchange and chose not to participate in the extended Medicaid program, thereby creating large numbers of Texans without access to basic medical care. The 35% of Texans without insurance put enormous financial pressures on Texas hospitals. In Dallas, the rate of uninsured is 30% (635,000).

To get borderline patients admitted, the ER physician has to get a skeptical hospitalist or primary care internal medicine physician to agree to accept the admission. Emergency physicians can't admit a patient without another physician willing to accept the admission! Hospital administrators - via utilization review coordinators intensely focused on reducing preventable admissions - exert tremendous pressure on admitting physicians not to admit “borderline” patients without insurance. Hospitalists employed by the hospitals, sensitive to hospitals’ financial concerns and financial incentives in some cases, act as a first line of defense in keeping marginal admissions out of the hospital.

Both private and public hospitals are prohibited by law from denying a patient care in an emergency. The Emergency Medical and Treatment Labor Act (EMTLA) passed by Congress explicitly forbids the denial of care to indigent or uninsured patients based on a lack of ability to pay.

Will Federal and Texas health regulators investigate whether Texas Health Presbyterian Hospital of Dallas performed the proper screenings for infections, and why it didn’t hospitalize the Liberian man when he first entered its ER?

Texas, as well as the nation, is intentionally, deplorably unprepared to manage any serious public health problems, as Karen so well describes.

It is interesting that the single biggest medical force on the Ebola frontline has been a small island of Cuba.

http://www.theguardian.com/world/2014/oct/12/cuba-leads-fights-against-ebola-africa

annenigma said...

I've had my own nightmare experiences in the ER so I know what can go wrong and how patients are treated differently. If you show up with chest pain and you're a woman, you can expect to be sent home to finish having your heart attack. Insurance status makes no difference at all. Healthy looking, active women just don't have heart attacks - just as feverish patients in Texas don't have Ebola.

Denis Neville said...

@ annenigma

Your nightmare “show up with chest pain and you're a woman” experience in the ER reminded me of the time my wife went to the ER with chest pain.

The young cardiologist on call was finally (reluctantly) consulted by the ER to see “a middle aged, slightly overweight female who was persistently complaining of chest pain.” He later told us that he thought that she would be ‘just another woman with chest pain’ as headed over to the ER.

It turned out that she had a large tumor (leiomyosarcoma) in her heart that extended into her inferior vena cava.

When he visited my wife just before she died two years later, he told me that he would never forget her and that he always used her as an illustration to his residents to never dismiss ‘just another woman with chest pain’ as he had done once in the past.

annenigma said...

@Denis

I'm sorry about your wife. I'm sure you did everything you could for her. That's always some comfort.

I've been thinking of the Dallas ER doc a lot lately and I can't imagine the deep remorse and regret he must be feeling for his grave and very public error. It has to be very difficult to live with that burden. I only hope he becomes a far better doctor because of it and doesn't give in to despair.

Pearl said...

Denis: Sometimes we do all we can for those we love only to not have the kind of medical help and knowledge to save them. I was the woman WITHOUT chest pains who no doctors over the many years did anything about despite my continuing high cholesterol reports or questions I asked and with a family history of heart disease. Not until severe damage had been done and became obvious by an abnormal heartbeat in my 70's did emergency surgery save the day. My husband suffered more from medical neglect than the actual illnesses they ignored which constricted his life for many years. As a result I began to educate myself via medical books and caught a number of problems that doctors had ignored in family members and friends.
It is hard enough to lose someone you love and in addition wonder if it might have ended differently with proper care.
A recent NYTimes questionnaire about wrongful diagnoses or unhelpful medications by the medical profession found that the main reason for these mistakes was due to the small amount of time they took to interact with patients and did not encourage questions. I always walk into a doctor's office with appropriate questions on a list and do not allow them to rush me. I often find I know more about the problem and its cause than the doctor.
As you know, we have a long way to go, Denis. I am sure your wife died knowing what a wonderful man she was leaving behind who had done everything possible to save her life.
People must be encouraged to educate themselves about health matters and have the courage to confront a doctor if necessary - if they are lucky enough to be able to find one and get the necessary care.
Even with a better health care system in Canada, I have not found many doctors whose opinion I trust or depth of knowledge I respect.
Reading reports about medical training of future doctors does not give one a sense of security either.

Fred Drumlevitch said...

Good post, Karen.

And @Denis and @annenigma --- in the words of that old commercial: Stop, you're both right. That old commercial featured two people arguing only about the benefits of a breath mint. Obviously, medical care is far more important than that --- and so should merit much stronger opinions. But the fact is, what both of you (and others) have said is true. The U.S. medical system is broken on many levels, and in countless ways --- access to care, cost, profits, incentives, competence, and further compounded by sometimes unrealistic public expectations regarding the power of medical intervention, and personal unwillingness to behave responsibly (i.e. manage weight (doubly-so if diabetic or pre-diabetic), cease smoking, etc).

My sympathies to you, Denis, on the death of your wife. I think that most people in this country have their own tales of inadequate medical care, for themselves or someone close. Many years ago, my late father had successful back surgery --- but died less than a year later from undiagnosed heart disease, though he had good medical insurance. An aunt of mine died in horrible condition from ovarian cancer --- which wasn't diagnosed until too late, by the sixth physician she saw. (This was decades ago, prior to scans being used as widely as they are now. Still, it shouldn't have taken that long for a diagnosis). Another aunt died from smoking-related lung cancer --- or perhaps it was actually prematurely from what may have been overly-aggressive treatment. Another aunt, in hospital, was the one who noticed and alerted to a serious mistake about to be made to the patient in the next bed by the nursing staff. And I've seen a physician fail to notice a drug contra-indication listed in my mother's medical file. ...

Zee said...

@annenigma--

Thanks for your observations--and related experiences--as a "retired public health nurse in the area of infectious disease control and prevention." They were very enlightening, at least to (layperson) me.

I can only speak for myself, of course, but I am finding the At-The-Speed-of-The-Blogosphere/Twittersphere, witch-hunt-like searches for—and Media/Internet Trial and Conviction of—those “responsible” for the death of Thomas Eric Duncan to be monumentally depressing.

Though not surprising.

Science and systematics be damned, we need a scapegoat! Pronto! And preferably one that matches our preconceived notions.

In the mad dash to score political and moral points against one another, nothing seems to be off the table at which to instantaneously point the finger of blame: racism; “insurancism;” physician/nurse incompetence/negligence; the inadequacy of our medical records-keeping and/or communication systems; Obama's failure to act to properly secure the borders and/or cancel flights from the affected African nations; funding cuts to the CDC; all of the above; none of the above; and/or maybe some things that I haven't thought of yet, but probably will at 2:00 tomorrow morning.

Even Jesse Jackson has been poking around down in Dallas, probably looking for an “in” to wave the bloody shirt of racism and maybe score a few bucks for the Rainbow Coalition along the way. Though judging by his muted exit from Dallas, he hasn't been able to find such an “in”—thus far. Maybe Al Sharpton will find a better angle.

http://www.wfaa.com/story/news/health/2014/10/08/ebola-jesse-jackson-dallas-tx-patient/16889201/

We are confronted with a serious health issue, stateside, that demands a more reasoned and calm response than what I am hearing on the Blogosphere/Twittersphere. But it's apparently more entertaining to cast instantaneous blame and demand impossible cures—impossible at least in the short-term—than to think things through.

And let's not forget that, in the end, Ebola is a serious disease with an average mortality rate of 50%.

http://en.wikipedia.org/wiki/Ebola_virus_disease

Amongst all of the various “hypotheses” being entertained as to who/what is “responsible” for Thomas Eric Duncan's death, is it possible that he was actually luckier to be here in the United States for palliative treatment—even in a maybe-hypothetically-lousy Dallas hospital—instead of in Liberia, and yet, his luck just ran out?

I mean, really; we've had all of what—two or three cases thus far, stateside—on which to test out our methodologies and medications?

It is, of course, very important that we continually learn from our mistakes. But that doesn't necessarily mean that we need to burn anyone at the stake along the way.

annenigma said...

I wonder if the big banks and other corporations are increasing their purchases of 'dead peasant' insurance in light of the Ebola virus hitting our shores. They could really make a killing on early deaths from Ebola. I wonder if they've been 'investing' in Africa recently.

COLIs and BOLIs are Corporate/Bank Owned Life Insurance policies that the banks and other big corporations secretly buy on their employees lives and make themselves the beneficiaries. But there's more to it than just betting on buying the farm.

"One reason banks are enamored with taking out policies on other people’s lives and keeping the practice as hush-hush as possible with the willing consent of regulators is that the gullible U.S. taxpayer who bailed out the banks to the tune of trillions of dollars from 2008 to 2010 and is now subsidizing too-big-to-fail through an implied permanent Federal backstop, is also subsidizing these death wagers. Both the buildup in the cash value of the policy over time and the payment of the death benefit are tax-free income to the bank; the more workers they insure, the more tax-free income they receive to help their bottom line; and the less corporations pay in their share of Federal income taxes, shifting more and more of the burden to the struggling middle class."

I seem to have read that they also buy policies of total strangers. With so much money and so many tax advantages to doing so, I suppose they could have already bought a policy on all of us.

If you can stand to read more on this disgusting practice, check this out:

http://wallstreetonparade.com/2014/03/document-jpmorgan-chase-bets-10-4-billion-on-the-early-death-of-workers/

Fred Drumlevitch said...

A couple of points not yet raised here:

Apparently, 2003 changes in Texas law make it very difficult for anyone to win a successful medical malpractice lawsuit. But if they should win, Texas law (as is usual with these generally-Republican-instigated state laws restricting lawsuits) is structured to most-seriously penalize a poor plaintiff.

http://www.nbcnews.com/storyline/ebola-virus-outbreak/could-hospital-face-ebola-death-lawsuit-success-unlikely-experts-say-n221591?cid=eml_nbs_20141009

from the article:

"a person administering emergency care in good faith 'is not liable in civil damages for an act performed during the emergency unless the act is willfully or wantonly negligent'. [...] There is no cap on awards for economic damages such as lost wages or loss of future income. But if a patient wins an award for pain and suffering against a physician, it is capped at $250,000. A patient suing a hospital or multiple hospitals can only be awarded damages of up to $250,000 per hospital, up to an overall maximum of $500,000."

Zee said...

@annenigma--

Thanks for the link to the article on the disgusting practice of banks and corporations insuring employees against death, even after they have left the bank or corporation and may no longer be considered key employees.

“One bedrock of insurance law dating back to the 19th Century is that a party must have an insurable interest in the life of another person in order to take out an insurance policy. The U.S. Supreme Court held in Warnock v. Davis in 1881 that 'in all cases there must be a reasonable ground, founded upon the relations of the parties to each other, either pecuniary or of blood or affinity, to expect some benefit or advantage from the continuance of the life of the assured. Otherwise the contract is a mere wager, by which the party taking the policy is directly interested in the early death of the assured. Such policies have a tendency to create a desire for the event. They are, therefore, independently of any statute on the subject, condemned, as being against public policy.'” (My bold emphasis.)

How ghoulish!

And yet,

“When the General Accountability Office (GAO) looked into the matter [of Bank and Corporate Owned Life Insurance] for Congress in 2003 and 2004, it found the insidious practice of continuing the life insurance even after the employee had left the company – nullifying any ability to consider him or her a 'key' to the business. The GAO wrote: 'Unless prohibited by state law, businesses can retain ownership of these policies regardless of whether the employment relationship has ended.' The GAO found that multiple companies held life insurance policies on the same individual.” (My bold emphasis.)

So the banks and corporations are quite literally “wagering” that enough of their employees will die sufficiently prematurely that they—the banks and corporations—can turn a net profit on the bet.

Sickening.

I wonder if the banks and corporations further tip the odds in their favor by offering crappy health insurance to their insured employees, the better to help them into premature graves.

annenigma said...

@Zee

The Corporate Person who continues to insure former employees by claiming them as permanent assets to their company reeks of slavery - owning people as property. Their flimsy rationale behind insuring the lives of their employees and making themselves the beneficiary is that employees are property of the company which needs protection against loss that might harm the company. So what are they doing while they're still alive to ensure their health and well-being?

Boy, talk about turning things on their head - the corporation is legally the person and the employee is legally their property, at least according to the Supreme Court and Congress. It reeks of a financial form of slavery to me. The rot of vulture Capitalism is in the air.

Isaiah Earhart said...

Great discussion!

Zee said...

@Fred and @All--

Malpractice Law in Canada? Part I

You pointed out that the State of Texas has “[made] it very difficult for anyone to win a successful medical malpractice lawsuit. But if they should win, Texas law (as is usual with these generally-Republican-instigated state laws restricting lawsuits) is structured to most-seriously penalize a poor plaintiff.”

You further observed that the Texas law states that:

“'a person administering emergency care in good faith “is not liable in civil damages for an act performed during the emergency unless the act is willfully or wantonly negligent”. [...] There is no cap on awards for economic damages such as lost wages or loss of future income. But if a patient wins an award for pain and suffering against a physician, it is capped at $250,000. A patient suing a hospital or multiple hospitals can only be awarded damages of up to $250,000 per hospital, up to an overall maximum of $500,000.'”

Because Canada's single-payer health-care system is frequently held up as the model that the U.S. should aspire to, I was curious about malpractice law in Canada.

It appears to me that for reasons somewhat different from the U.S., Canadian malpractice laws are not particularly sympathetic to their poor, either.

Here are three articles on the topic, followed by a couple of excerpts therefrom:

http://www.theglobeandmail.com/life/health-and-fitness/health-navigator/patients-odds-of-winning-medical-malpractice-suits-in-canada-arent-good-says-new-book/article10812604/

http://www.tampabay.com/news/canada-keeps-malpractice-cost-in-check/1021977

http://lawecommons.luc.edu/cgi/viewcontent.cgi?article=1349&context=annals

From the first article,

“The chances of a patient winning a medical malpractice lawsuit against a doctor in Canada are slim, according to a new book entitled After the Error: Speaking Out About Patient Safety to Save Lives.

The book, put together by microbiologist Susan McIver and retired nurse Robin Wyndham, contains a collection of stories about patients who said they suffered from medical errors while being treated in the health-care system. Citing various studies, the authors say these mistakes contribute to between 38,000 and 43,000 deaths in Canada each year and many more individuals suffer serious harm.

One chapter, by Halifax lawyer John McKiggan, focuses on the ability of patients to obtain financial compensation through the courts. He writes that every medical error, known as an 'adverse event,' is a potential malpractice case. Although exact numbers are hard to come by, McKiggan estimates that medical errors could theoretically generate over 100,000 lawsuits every year. Yet relatively few errors result in litigation. From 2005 to 2010, only 4,524 lawsuits were filed against Canadian doctors. During that five-year period, 3,089 claims were dismissed or abandoned 'because the court dismissed the claim or the victim or the victim’s family quit, ran out of money or died before trial,' according to McKiggan.
And out of 521 cases that went to trial, only 116 led to a judgment that favoured the patient. And the median damage awarded was just $117,000, he noted.”

Zee said...

Malpractice Law in Canada? Part II

And why do victims or their families “[run] out of money...before trial?”

Well, perhaps because in Canada—unlike the United States— lawyers often don't work on a contingency basis. Plaintiffs and their attornies have to foot the bill for their lawsuit upfront and hope to recover costs after a guilty verdict.

From the second article,

“Canadian law firms, unlike U.S. firms, often require plaintiffs to pay for an initial investigation to determine whether the claim has merit. That cost discourages many people from pursuing a lawsuit.

Another deterrent, plaintiffs' attorneys say, is that the Canadian Medical Protective Association is aggressive in defending its members because it is in the unique position of insuring virtually all of the country's 76,000 or so doctors.

'It's different from the U.S., where you have a great number of private insurers, each with a different corporate mentality to litigation,' says Richard Halpern, a Toronto attorney.

'Here, we don't see nuisance payments to settle cases, we see where the CMPA is prepared to throw all the money at it to defend it no matter what it's worth. Litigation in Canada is therefore very, very expensive, and there are very few plaintiff's lawyers with the wherewithal to carry through with these cases.'

The association's legal fees have risen, but its track record is strong: Of the cases tried in 2007, judgments went in the patient's favor 25 times and the doctor's 70 times. The median amount of damages was about $91,000.

Although Canada allows jury trials, the few cases that go to court are usually tried in front of a judge.”


So for somewhat different reasons than the State of Texas, the Canadian system doesn't appear to be particularly easy on the poor either. Those unable to foot the bill upfront for an investigation are SOL, no matter the merit of their case. And I suspect that judges are generally far less easily swayed to guilty verdicts and large settlements than are juries, even if a poor plaintiff actually makes it to trial.

In addition,

“In 1978, the Canadian Supreme Court limited damages for pain and suffering. Adjusted for inflation, the cap now is just over $300,000.” That cap isn't all that much different than Texas'.

This summarizes the research that I've done on my own. I would be interested to hear what our Sardonicky ex pats in Canada have observed.

Fred Drumlevitch said...

@Zee:

Thanks for your look into the Canadian malpractice situation. Yes, it appears to be a similar result, though for different reasons. Like you, I'd be interested in hearing about this from Canadian commenters here at Sardonicky.

I've got things to do currently, but hopefully will have the time late this evening to add a few words.

Pearl said...

Zee: Thank you for taking the time to outline the Canadian situation involving malpractice suits brought by patients to their doctors. It is detailed information that rings true in my own information mostly by reports in the Toronto Star of the difficulty of anyone winning or even able to bring a suit against a doctor. Unfortunately, the attitude of doctors here in Canada as in the U.S. is to protect their own (and personally remain in the good graces of their fellow colleagues in case they are also sued). When the birth of Universal Health Care was passed, thanks to the indomitable struggle of the NDP, doctors went out on strike but did not get the people's support and had to give in. Every meeting between the government and the Doctors Association now is always fraught with argument and I believe the majority of doctors in service are not basically enamored of the universal coverage in place. Surprisingly most of the population is, regardless of political points of view and is the reason it continues to function.
I believe from what I have read about particular cases that get in the news and now your information, Zee, it is indeed difficult financially,and timewise for a patient to get involved successfully and there are evidently doctors who are allowed to practice even after evidence is given of malpractice.
That is the best I can offer and although as I recently posted to Karen's current comment, I enjoy the benefits of the care I receive here, but have just as much criticism of many doctors as in the United States. They are a breed unto themselves but I am sure many do care seriously about their work and perhaps with the admission of so many female doctors into the profession might have more compassion for patients, especially those who live in poverty.
Karen has certainly brought out so much information between all of us in her excellent column (belongs in Truthought) and I find it very stimulating and important. At least it has moved the ISIS reports off the front page except for an occasional article about having to rethink their aerial attacks in various spots so I am afraid they are trying to prepare us for an all out boots on the ground war everywhere they can go.

Jay - Ottawa said...

Gee, Pearl, I think Zee is putting us Canadians on the spot with his deep reading.

Let’s see, in one country (Canada) few people get far litigating against medical malpractice; BUT otherwise just about everybody is covered with pretty good healthcare, and even families struck with a tough diagnosis don’t routinely go bankrupt because of medical bills. Oh, and by most indices Canadians are healthier and live longer than folks south of the 49th parallel.

Then, in another country (Texas :-) few people get far litigating against medical malpractice; AND only the pretty well-off get healthcare, and then only in proportion to their wealth. Furthermore, the second tier (Medicaid) of their two-tier system is being cut back and held back so as to serve fewer poor even more poorly. With rare exception a family eligible for first-tier medical service (through the fix-is-in private health insurance) will go bankrupt soon enough if one of its members gets hit with a tough diagnosis.

So, at the end of the day the question is, which system is worse –– or at least more open to criticism? Tough call, eh!

Pearl said...

Jay: You have convinced me. I think I'll remain in Canada because even though I have criticized doctors in both countries, at least I will have a doctor here whom I can argue with if I don't get too rambunctious.

Jay - Ottawa said...

Money, Class & Usury

We might reflexively connect the term Usury –– lending money at interest –– with its outmoded condemnation by Christian moralists of the Middle Ages. Didn’t those anti-business moralists realize they were standing in the way of capitalism?

However, glancing through the first paragraphs of Wiki, I see that Usury has also been condemned by many other cultures over several millennia, often for good reason.
http://en.wikipedia.org/wiki/Usury

I wonder whether in the modern world, big banking and high finance aren’t practicing very subtle and artful forms of what still boils down to Usury at its ugliest. At other times, of course, what is really going on in the high rise of big banking is not the enslaving loan practices of usury but something else, outright theft, which is illegal. (Eric Holder already puts people in jail for white-collar crimes like Theft.) Should Usury also be put on the books as a crime? Might be easier for Holder to fill our private jails if more people were put in the slammer for Usury.

I raise the Usury-as-a-grey-crime issue in the context of comments above. Let me propose, as a thought exercise (since there’s no chance of real law follow-through), that ANY profits derived purely from financial transactions (as distinct from material production) be considered dirty money, subject to a heavy “sin-tax,” for the same reason the state imposes exorbitant taxes on cigarettes. Cigarettes destroy health. Usury destroys people and their economies.

If you make money simply by spinning it through a computer on hollow mortgage schemes or bets on when people will croak, well, you’re a usurer and a cheating gambler to boot. You should be firmly discouraged from continuing such anti-social practices. Just sayin’.

Neil said...

This story is a must read,

Dallas nurses: Ebola victim sat for hours in room with other patients

http://www.stripes.com/news/us/dallas-nurses-ebola-victim-sat-for-hours-in-room-with-other-patients-1.308292

By Tina Susman and Geoffrey Mohan
Los Angeles Times (MCT)
Published: October 15, 2014

DALLAS — A Liberian man who arrived by ambulance at a Dallas hospital with symptoms of Ebola sat for “several hours” in a room with other patients before being put in isolation, and the nurses who treated him wore flimsy gowns and had little protective gear, nurses alleged Tuesday as they fought back against suggestions that one of their own had erred in handling him.

The statements came as Nina Pham, a 26-year-old nurse at Texas Health Presbyterian Hospital in Dallas, fought off the Ebola virus after contracting it from the Liberian, Thomas Eric Duncan. The statements by the Dallas hospital nurses were read by representatives of the Oakland, Calif.-based group National Nurses United.

RoseAnn DeMoro, executive director of National Nurses United, said the nonunionized Texas nurses could not identify themselves, speak to the media independently or even read their statements over the phone because they feared losing their jobs. In a conference call, questions from the media were relayed to the unknown number of nurses by National Nurses United representatives, and the responses were read back to reporters.

DeMoro said all of the nurses had direct knowledge of what had transpired in the days after Duncan arrived at the hospital on Sept. 28.

Among other things, they said that Duncan “was left for several hours, not in isolation, in an area where other patients were present.”

When a nurse supervisor demanded that he be moved into isolation, the supervisor “faced resistance from other hospital authorities,” the nurses said.

They described a hospital with no clear guidelines in place for handling Ebola patients, where Duncan’s lab specimens were sent through the usual hospital tube system “without being specifically sealed and hand-delivered. The result is that the entire tube system, which all the lab systems are sent, was potentially contaminated,” they said.

“There was no advanced preparedness on what to do with the patient. There was no protocol; there was no system. The nurses were asked to call the infectious disease department” if they had questions, they said.

The nurses said they were essentially left to figure things out for themselves as they dealt with “copious amounts” of body fluids from Duncan while wearing gloves with no wrist tapes, gowns that did not cover their necks, and no surgical booties. Protective gear eventually arrived, but not until three days after Duncan’s admission to the hospital, they said.

The nurses’ allegations conflict with what hospital officials have been saying since Duncan’s admission: that they have strict protocols in place for handling such patients and that a mistake led to Pham becoming infected while she treated him....more..

Denis Neville said...

Comparing medical malpractice systems in other countries to that in the US:

When examining foreign liability models, one factor to consider is the larger social systems within that country. The medical liability system is often inextricably linked with the health care system.

For example, because Sweden, Canada and the U.K. have forms of universal health care coverage, the government covers most liability claims or subsidizes physicians' coverage. As a result, settlements are more common, and liability doesn't hit doctors in their pockets, so you don't see as much defensive medicine as in the U.S.

Nor is access to care as dire, because liability costs aren't forcing doctors to limit their practices.

http://www.amednews.com/article/20100503/profession/305039938/4/

All claims in Britain are against the NHS, which has a policy of settling meritorious claims as fast as possible. They also has far more options for paying lawyers. There is public funding of civil lawyers for the poor. It has legal expenses insurance that funds plaintiff’s litigation.

http://www.loc.gov/law/help/medical-malpractice-liability/uk.php

http://www.nhsla.com/Pages/Home.aspx

http://www.avma.org.uk/pages/specialist_leaflets.html

Zee said...

@Denis--

Thanks for the amednews.com article that compares in some detail the different ways in which developed countries handle medical malpractice claims.

The fact that there are so many differences from country to country, even amongst nations that offer universal health care (in one form or another), persuades me that my interest in comparing U.S. and Canadian malpractice law should not be seen as an altogether frivolous one.

It seems that the U.K.'s system is more generous (and timely) in providing court access, legal support and compensation for malpractice to even Britain's poorest than Canada's, even though the latter country also offers universal access to good health care to its citizens.

While I would not care to see Canada go Britain's way and totally nationalize its health care system, even the former country could perhaps benefit from some “tort reform.”