ER visit - wwyd?

[EasterJoy]

Thank you for using your contacts, EasterJoy.

Hoosier, I think a lot of people had good advice without actually being a doctor or lawyer, though one never knows who is, or isn’t on CAF. Not everyone puts their life out there.
Also, without giving away details, some people may be advising because of similar circumstances they encountered.

If the hospital says, “You’ll pay it, or we’ll sue, and we don’t care if you contact the medical board about our care,” then it is time to decide whether to call their bluff or not.

The physician I talked to did not know of that happening in a case like this, because the hospital rarely wants to go to the expense of going to court over a relatively small charge that could get very big (in bad publicity, lawyer’s fees, a lost case in the end and possibly a malpractice lawsuit on top of all) if they anger the family and then patient has a bad outcome down the line. They’d rather placate the family for a relatively small sum and hope the issue just goes away.

I wouldn’t handle this in a way that might make the administrator dig his or her heels in a “you so-and-so, I’ll show you that you can’t threaten me!” way, but if the OP is firm rather than vitriolic about it, the chances are very good that the hospital will let the matter go.

 

[Hoosier_Daddy]

Thank you for using your contacts, EasterJoy.

Hoosier, I think a lot of people had good advice without actually being a doctor or lawyer, though one never knows who is, or isn’t on CAF. Not everyone puts their life out there.
Also, without giving away details, some people may be advising because of similar circumstances they encountered.

There are several attorneys and doctors on here. But that doesn’t really matter.
The point is that her pediatrician over a three or four (that should be cleared up) instructed her to go to the ER. The ER is a triage. It isn’t a diagnostic department. When the op took the child to a specialist the problem was discovered. If the op wishes to pursue legal avenues that is her right. She will have to prove the ER did something wrong. Beyond that as a parent with children who has run into medical situations I am quick to note when my own emotions get to me. No care would be adequate for my child. That being said. With the information given I’d say the ER did its job. I also think a personal discussion with administration is going to be productive.
But when people start throwing around legal fax s about IVs and talking about malpractice I think the rational has been left behind.
Since the original pediatrician kept referring to thevER instead of the specialist perhaps they would advocate on behalf of the patient. Or shoulder some of the cost.

 

[BlueEyedLady]

Just for the record, I got the advice to refuse to pay the bill from an emergency room doctor and also from a cancer patient who refused to pay a hospital that misdiagnosed him and lost his lab results. Refusing to pay when medical services are incompetent is a real option. Insisting on payment for the misdiagnosis and non-treatment of an infant who ought to have been admitted to the hospital is a big mistake.

The hospital has no way to know they are billing for incorrect care until the patient protests the bill, especially in a case where the patient did not return to their hospital for the correct diagnosis. When they get evidence that they’ve done that, they do not tend to press to get paid. Having said that, hospitals do sometimes turn down people who merely “ask” to have a bill for bad care “forgiven.” It is the patient who is in the position to forgive bad care, not the hospital. Rather, it is better to call and say, “I’m not paying this bill, and this is why. I can supply more evidence in the form of medical records from your competitor who actually got this right, if you need it for your records.”

There is a good chance that a discussion with the hospital will result in a reduction of the bill, if for no other reason than PR. It’s common.

However, responsibility for medical bills is not contingent on a correct treatment, test, or diagnosis as long as the medical team acted in good faith and in accordance with medical standards and good sense. Misdiagnosis are unfortunately, very common and costly for patients.

Will the hospital sue over $600. No, that’s laughable. Will they turn it over to collections? Oh probably. If there’s going to be legal action, the OP will have to initiate it. And over a $600 bill that she won’t win on if the hospital can prove they behaved reasonably and responsibly? That seems like an expensive headache to me.

My first step would be to ask, and then to argue, all the way up the chain of command. But if the answer is ‘no’, really the only reasonable thing to do is consider how much you value your credit score. Hospitals see thousands of patients every day and incorrect tests, treatments, and diagnosis are part of the territory. Threats of a lawyer over one day of wrong tests and diagnosis is not going to scare them - they have a team of lawyers adept at defending much worse.

 

[EasterJoy]

There is a good chance that a discussion with the hospital will result in a reduction of the bill, if for no other reason than PR. It’s common.

However, responsibility for medical bills is not contingent on a correct treatment, test, or diagnosis as long as the medical team acted in good faith and in accordance with medical standards and good sense. Misdiagnosis are unfortunately, very common and costly for patients.

Will the hospital sue over $600. No, that’s laughable. Will they turn it over to collections? Oh probably. If there’s going to be legal action, the OP will have to initiate it. And over a $600 bill that she won’t win on if the hospital can prove they behaved reasonably and responsibly? That seems like an expensive headache to me.

My first step would be to ask, and then to argue, all the way up the chain of command. But if the answer is ‘no’, really the only reasonable thing to do is consider how much you value your credit score. Hospitals see thousands of patients every day and incorrect tests, treatments, and diagnosis are part of the territory. Threats of a lawyer over one day of wrong tests and diagnosis is not going to scare them - they have a team of lawyers adept at defending much worse.

She ought to talk to her child’s physician. According to the ER doc I asked about it, this is not a miss that an emergency physician is going to get an “oh, well, sometimes we miss things” pass on. Apparently, their specialty is ruling out uncommon but very bad things, and this is a very bad thing that the standard of care required to have ruled out, particularly considering the duration of the condition. It doesn’t help the looks of things that they decided not to start an IV only because they couldn’t succeed in starting one. In other words, this was not a patient who came in, left against physician advice, and now doesn’t want to pay for being seen. Yes, hospitals go after patients like that with both guns blazing.

If it were me, I’d supply the correct diagnosis which resulted in a hospital admission to the first hospital, refuse to pay and see what happens. No, I would not pay an attorney to handle this. People take this kind of thing up on their own with the billing departments of hospitals all the time.

 

[BlueEyedLady]

She ought to talk to her child’s physician. According to the ER doc I asked about it, this is not a miss that an emergency physician is going to get an “oh, well, sometimes we miss things” pass on. Apparently, their specialty is ruling out uncommon but very bad things, and this is a very bad thing that the standard of care required to have ruled out, particularly considering the duration of the condition. It doesn’t help the looks of things that they decided not to start an IV only because they couldn’t succeed in starting one. In other words, this was not a patient who came in, left against physician advice, and now doesn’t want to pay for being seen. Yes, hospitals go after patients like that with both guns blazing.

If it were me, I’d supply the correct diagnosis which resulted in a hospital admission to the first hospital, refuse to pay and see what happens. No, I would not pay an attorney to handle this. People take this kind of thing up on their own with the billing departments of hospitals all the time.

Yes, she should definitely take it up on her own, repeatedly and firmly with every piece of backup documentation she has. My bet would be, the OP will get a break.

But I would not go off the assumption that she’s somehow legally not responsible for the debt, or that she’ll be able to show it in court without spending a lot more than $600. And if insurance has already paid its portion, that stacks the deck even more.

Misdiagnosis are so common, even in ER. But they really aren’t a legal problem. The idea is that medicine is an imperfect science and decisions are made very quickly by imperfect people. Penalizing, or even failing to compensate doctors or hospitals when mistakes, even life threatening ones, are made would cause almost everyone to flee the profession while the few who remained would be paralyzed in decision making. The extremely high bar for holding Drs and institutions responsible for bad decisions exists for a reason. Given the number of IVs nurses give up on, unnecessary tests run, and incorrect ER diagnosis made every day, I just don’t think it’s wise to go in with the attitude that she’s not paying and there’s no consequence she could reasonably suffer for that decision. Unless there’s something missing in the story, this is an extreme circumstance for the OP, but it’s pretty routine for the hospital.

In all likelihood, they’ll drop or reduce the bill. If they don’t though, they’ll turn it over to collections after so many days of nonpayment, and the OP will start getting calls from 800 numbers. From there, if she really doesn’t want to pay, she can let it sit on her credit until it’s eventually written off in 7-10 years. I just don’t see a $600 bill going to court. Do you have any idea how many Americans owe ER debts in the tens or even hundreds of thousands? This is just a non issue to the hospital.

 

[nodito]

Misdiagnosis are so common, even in ER. But they really aren’t a legal problem. The idea is that medicine is an imperfect science and decisions are made very quickly by imperfect people. Penalizing, or even failing to compensate doctors or hospitals when mistakes, even life threatening ones, are made would cause almost everyone to flee the profession while the few who remained would be paralyzed in decision making. The extremely high bar for holding Drs and institutions responsible for bad decisions exists for a reason. Given the number of IVs nurses give up on, unnecessary tests run, and incorrect ER diagnosis made every day, I just don’t think it’s wise to go in with the attitude that she’s not paying and there’s no consequence she could reasonably suffer for that decision. Unless there’s something missing in the story, this is an extreme circumstance for the OP, but it’s pretty routine for the hospital.

I feel like there’s a difference between suing a doctor for medical malpractice and refusing to compensate a doctor or hospital failing to do the job you hired them for. I’m not a litigious person. I don’t plan on taking this to court. The more I think about this, though, the more confident I am that I shouldn’t have to pay this bill.

I went to the Emergency Room because my daughter seemed very ill. It seemed like an emergency. I hired the doctors there to examine her and tell me if she had a serious illness (and if so to treat it) or whether she would recover on her own. They were unable to perform a basic function of hospitalists (start an IV) and they said she was fine without recommending an ultrasound of her abdomen (which is how the other ER diagnosed her). I think this was substandard care.

I can’t think of any other industry where we compensate a professional for poor or inadequate service just because we don’t want them to leave the field. In my mind, we should hold hospitalists accountable for being unable to start an IV in a child after six attempts (as an aside, the children’s hospital ER nurse got it in the first try) or for sending a child home that has a life-threatening condition without even floating the suggestion of additional tests.

I think that until recently, people didn’t care about the high cost of medical services because insurance covered it all. Now that more people have high deductible plans, we’re seeing how much these services cost. There’s bound to be pushback from consumers like me who feel like the charge isn’t justified by the services received. In theory, this should lead to increased standards of care, more cost transparency,and more business going to more competent physicians.

But to update the situation, I called the billing department and the rep I spoke with advised me to fax them a letter of dispute explaining that I went to a separate ER after I left the local one. I faxed the letter this afternoon and will call back in a couple of days to follow up. I’m hopeful they’ll waive the charge, and I’ll be sure to update y’all regardless.

 

[nodito]

When the op took the child to a specialist the problem was discovered.

I never took her to a specialist, I just took her to a different emergency room. The ER was in a children’s hospital but I don’t think that qualifies them as specialists.

 

[Hoosier_Daddy]

I never took her to a specialist, I just took her to a different emergency room. The ER was in a children’s hospital but I don’t think that qualifies them as specialists.

Well it specializes them in children and diagnostics when communication is not available with patients.

I’m still stuck on the original pediatrician going three or four days and just giving no you ER referrals.

On this thread you ask what we would do. I think most suggestions were good.
Way more important than the 600 is your child is ok now and out of danger. Yes you did have to move around to figure it out but I’m so happy you did figure it out! That is a blessing!
And I hope you can negotiate the bill.

 

[Hoosier_Daddy]

I feel like there’s a difference between suing a doctor for medical malpractice and refusing to compensate a doctor or hospital failing to do the job you hired them for. I’m not a litigious person. I don’t plan on taking this to court. The more I think about this, though, the more confident I am that I shouldn’t have to pay this bill.

I went to the Emergency Room because my daughter seemed very ill. It seemed like an emergency. I hired the doctors there to examine her and tell me if she had a serious illness (and if so to treat it) or whether she would recover on her own. They were unable to perform a basic function of hospitalists (start an IV) and they said she was fine without recommending an ultrasound of her abdomen (which is how the other ER diagnosed her). I think this was substandard care.

I can’t think of any other industry where we compensate a professional for poor or inadequate service just because we don’t want them to leave the field. In my mind, we should hold hospitalists accountable for being unable to start an IV in a child after six attempts (as an aside, the children’s hospital ER nurse got it in the first try) or for sending a child home that has a life-threatening condition without even floating the suggestion of additional tests.

I think that until recently, people didn’t care about the high cost of medical services because insurance covered it all. Now that more people have high deductible plans, we’re seeing how much these services cost. There’s bound to be pushback from consumers like me who feel like the charge isn’t justified by the services received. In theory, this should lead to increased standards of care, more cost transparency,and more business going to more competent physicians.

But to update the situation, I called the billing department and the rep I spoke with advised me to fax them a letter of dispute explaining that I went to a separate ER after I left the local one. I faxed the letter this afternoon and will call back in a couple of days to follow up. I’m hopeful they’ll waive the charge, and I’ll be sure to update y’all regardless.

The update sounds promising.

However The automotive industry tis like this as well. If my car doesn’t run right and I pay to have someone look at it I still owe the bill even if it ended up being another mechanic that fixed it. Your analogy of hiring and refusal to pay isn’t correct. If you don’t pay, it goes to collections where the debt can be sold to a debt collector. This will damage your credit. The debt collector will then seek a judgement.
Yup. For only 600 dollars! Hospitals chase money all the time. Even from people who died
And that 600 is probably reduced anyway because even with deductibles there are agreements for services your insuranc negotiates for you.

If Obamacare is not reversed this will only get worse. Prices are skyrocketing and the mandate is a reason why.

I’ve negotiated prices for healthcare before with success. I think this will end up in your favor!

 

[nodito]

However The automotive industry tis like this as well. If my car doesn’t run right and I pay to have someone look at it I still owe the bill even if it ended up being another mechanic that fixed it.

Huh, that’s interesting. I was going to use a mechanic analogy to support my case! If I pay a mechanic to diagnose my car, which is squealing loudly, and he tells me I just need an oil change and that it will go away on its own and then the next day I break down on the highway and find out from a different mechanic that it desperately needs a new belt, I would argue the case with the first mechanic that I shouldn’t have to pay his bill.
Hoosier Daddy:

Your analogy of hiring and refusal to pay isn’t correct. If you don’t pay, it goes to collections where the debt can be sold to a debt collector. This will damage your credit. The debt collector will then seek a judgement.
Yup. For only 600 dollars! Hospitals chase money all the time. Even from people who died
And that 600 is probably reduced anyway because even with deductibles there are agreements for services your insuranc negotiates for you.

I realize that’s how this currently works. But if that’s the case and a person has to pay for a medical mistake or subpar care, then the system is broken.
Hoosier Daddy:

I’m still stuck on the original pediatrician going three or four days and just giving no you ER referrals.

I’m not really sure what you mean, but to clarify, I saw a pediatrician in his office on a Tuesday. He told me it was a stomach virus and that it would get better in a few days. On Saturday (five days later), after office hours, she still wasn’t better, so I called the pediatrician for advice, thinking he was going to recommend pedialyte or tell me the correct tylenol dosage. Instead, he advised me to go to the ER. My daughter seemed very ill but it never occurred to me until that point that she might have some life-threatening condition. As far as I’m concerned, he did his job well. The pediatrician knew what I didn’t; that when babies get sick and cry and it’s not getting better after five days something could be seriously wrong. We’re discharged from the hospital Saturday night with instructions to just keep nursing. Two days later when she’s still crying, I bring her back to the pediatrician’s office, a different pediatrician examines her and tells me to go back to the ER. He floats the word intussusception but can’t diagnose it with an ultrasound (and it would need to be treated at a hospital anyway). At that point, I drive to the children’s hospital because I think my local one is somewhat inept.
Hoosier Daddy:

Way more important than the 600 is your child is ok now and out of danger. Yes you did have to move around to figure it out but I’m so happy you did figure it out! That is a blessing!

I agree! Yes, you are completely right. I had people from CAF praying for her and I really believe God answered our prayers.

 

[LoveMercyGrace]

In what state is there a legal limit on the number of attempts to start an IV line? I have never heard of that one. What are you going to do if the patient needs to have an IV (which they usually do, or at least is expected to probably need one)? Say, “Sorry, but the law only allows three attempts, so you don’t get your IV treatment”? That’s unimaginable.

Sorry, just reading your post here.
there is ultrasound guidance to start a peripheral line, also other ways to access such as
a PICC line. it is considered-- in every standard of care for ( in this case a toddler) to have repeated IV attempts such as the mother described. its abusive… because there are alternatives.
also there are volumes written on this very subject if you are interested through google search or library.
peace and good

 

[Mummsie]

In what state is there a legal limit on the number of attempts to start an IV line? I have never heard of that one. What are you going to do if the patient needs to have an IV (which they usually do, or at least is expected to probably need one)? Say, “Sorry, but the law only allows three attempts, so you don’t get your IV treatment”? That’s unimaginable.

I believe after 3 attempts the protocol is to bring in a phlebotomist (sp?) / lab tech

 

[oldgraymare2]

Attempting to start a line, an IV, six times is considered abuse. The legal limit is three

attempts.

I would not pay the bill right away, and I would request a visit with whomever is in charge.

Misdiagnosing to a potentially fatal problem is a serious matter.

so very happy your baby is now ok!

God Bless

I am sorry my dear, but somehow you have been misinformed about the number of times for tries regarding a blood draw/getting an IV started, or for the person doing the blood draw.

I can tell you from personal experience that there is a limit of three attempts, but it is “per person” who is trying to insert the IV and get it started.

So it is limited to three times each for each phlebotomist or each nurse or each EMT and so on, and then the next person can try another three times. So in other words, each person can try three times.

In my case, if someone didn’t get it on three tries, they would ask me if they could get someone else in to try so that they could get the IV going, especially if I was having a surgical procedure or test done.

I am what is called a “hard stick,” where it is difficult for someone to find a working vein on me, but they get it done eventually. If I am quite ill and especially dehydrated, they have a more difficult time trying to find a vein.

They’ll sometimes then call in the most experienced/advanced staff person to help that they have on staff to then try and get a line started.

I have had an ultrasound used on me when all else failed.

I have also had a PICC line put in when I was going to have outpatient care and needed to go for IV antibiotics. This was done so that I didn’t have to have an IV constantly inserted.

 

[Boatswain2PA]

…11 month old daughter to the local Emergency Room because she wouldn’t stop crying…sick for a week…doctor called a stomach virus…pediatrician told us to go in to the ER because…didn’t seem to be getting better. The ER docs…probably a stomach virus…After trying six times (six!) they were unable to get an IV started…finally said that I could go home and just make sure I kept nursing her and hydrating her and to bring her back in if she seemed dehydrated.

Abbreviated for brevity. Probably 98% of immunized 11 month olds who come to the ED for illnesses have a virus and, as long as they can keep fluids down (nursing), then they will get better. An Emergency Provider’s (EPs) job is to find that 2% who won’t, but that’s very difficult.

Regarding 6 times to get the IV. There are absolutely NO “maximum number” of times to get an IV. I’ve seen many “kinda-sick” kids get more than that because they’re not “sick” enough for me to use an intraosseous (IO) or central venous line (CVL). You think it was terrible watching your child get stuck 6 times, try watching me LITERALLY drill a hole into her upper arm. This is a battery operated POWER TOOL that drills a needle into the BONE. I’m not adverse to using that if needed…and just about used one on a 2 year old last night (but my amazing nurse got the IV)…but it’s not my first choice. An IO or a CVL shouldn’t ever be used on a person who looks good enough to go home, even if they are keeping fluids down orally (ie: nursing).

To rephrase that a different way…if your baby was in my ED I may have ordered fluids via IV because she looked “kinda sick”, but not willing to use power tools (IO) or insert a CVL because she didn’t look sick enough to admit.

The discharge and return instructions appear to be appropriate. LOTS of kids who the parents think are sick come to the ED. Very FEW of them meet our criteria for “sick”. Yet every single “kinda-sick” kid I send home with mom/dad I tell them to come back if they get worse.

Why? Because sometimes the “tincture of time” is the best test we have in medicine.

 

[Boatswain2PA]

Two or three days pass…not getting better…in incredible pain…pediatrician tells me to go back to the hospital…well-regarded children’s hospital. She’s admitted and diagnosed almost immediately with intussusception which is an incredibly painful and potentially fatal telescoping of the intestines. Praise God the doctors were able to treat it and we were discharged from the hospital several days later.

Yes, praise God. It sounds like your first visit was to a smaller hospital without the resources of the pediatric ED. The “gold standard” test for intussusception is a barium enema, although a very skilled sonographer can find it as well. A CT scan can also find it, but is rarely used because the risk of radiation is often higher than the probability of finding intussusception (it is very, very rare). In many (most?) small hospitals there isn’t 24/7 sonography, and/or the sonographer isn’t competent to identify an intussusception. Again, this may sound terrible to a lay person (the ED provider and the sonographer is incompetent), but in reality the ED provider has likely only seen 1-2 cases of intussusception in their career, and the sonographer has likely NEVER seen it.

Also, and I am completely monday-morning quarterbacking here, the “2-3 days” without getting better means things have changed dramatically between the first ED visit and the second ED visit…namely that tincture of time has proven that it’s not going to get better. That should make any ED provider start thinking, again, that this may be one of the more rarer problems…and intusussception is up there on the list of problems for an 11 month old with abdominal pain.

Fast forward to this week. We have a high deductible insurance plan and just received a bill for the first ER visit, which is over $600. I’ve already paid the ER and hospital bill for the children’s hospital as well for as the pediatrician who saw her for a couple of sick visits. But I’m having a hard time with this $600 charge. I asked for an itemized bill and this is just the charge for the visit; they weren’t charging me for any procedures or unsuccessful IVs. I realize that we took up the doctors’ time and that they examined my daughter and spent time talking to me about her condition, but they also misdiagnosed her and she had life-threatening condition. They were unable to even treat her with fluids. And then I had to pay a second ER bill because they weren’t able to treat her. AND she had three more days of being in what I’ve since learned is excruciating pain, whereas if they had diagnosed her correctly she could have been treated right away.

So what would you do? Pay the bill? Dispute it somehow? Is that even possible?

And now we come to your question. Unfortunately that ED provider likely has absolutely no idea what the bill is, or what it is for. Most of us just see patients and do the best that we can while we leave the billing to the billing department.

I would say you are in a strong position to have the bill dismissed by the hospital using the various methods others have suggested. However, remember, if they don’t dismiss the bill they won’t “take you to court” over it, they will simply report you to the credit reporting bureau’s and ruin your credit.

I am very glad your daughter was (finally) appropriately diagnosed and treated. I do hope I am not the one who missed the initial diagnosis.

Attempting to start a line, an IV, six times is considered abuse. The legal limit is three attempts.

I would not pay the bill right away, and I would request a visit with whomever is in charge.

Misdiagnosing to a potentially fatal problem is a serious matter.

so very happy your baby is now ok!

God Bless

Is cutting a hole in the chest to insert a chest tube abuse? Is shocking someone with 300 joules of electricity abuse? Is pushing on someone’s chest hard enough to detach their sternum from their ribs abuse?

Sorry if I’m being unkind here, but your post is ridiculous. We are oftentimes required to do “hurt” (which you consider abuse) our patients in order to treat them. However we should ALWAYS consider the risk/benefit ratio to our treatments. I have ordered IV fluids on kids only to change my orders because a) they are difficult sticks and b) they don’t look toxic enough to admit (and thus get an IO or CVL).

1)…You need an attorney. However, it will cost you more to consult with an attorney than it will for you to pay the bill…they could have put an itraosseous catheter in if they couldn’t get an IV. They face that no ones could get an IV is disturbing…maybe she needed to be sedated to get the IV.

…my friend’s baby girl had the same problem…undiagnosed by 2 different physicians. …she was having jelly like stool, which, in children, is virtually diagnostic for intussusception…

That said, Intussusception isn’t usually a primary diagnosis. It is usually secondary to some GI disease. So, she probably wasn’t misdiagnosed but developed the intussusception because the GI disease was not brought under control quick enough.

Agreed about an attorney for legal questions, doubly agree that the attorney will cost FAR more than the $600 bill. The ONLY people who get rich off these situations are the attorneys.

You are correct that “currant jelly stools” is “virtually diagnostic” for intussusception. Unfortunately that is very uncommon to find in intussusception kids. I don’t think intussusception develops due to other GI disease, but I could be wrong. I’m not sure anyone (even GI docs) has a consensus on what causes it (outside of a few known reasons). However she likely had “intermittant” intussusception, where the bowel telescopes in and out from itself before it get stuck in, and becomes necrotic.

 

[Boatswain2PA]

…The ER…isn’t a diagnostic department.

Yes it is. It is often the primary diagnostic department in the hospital. And when the ED gets it wrong, patients often suffer greater morbidity and mortality.

That being said, the ED provider likely never saw this patient before, didn’t know the parents, and had very limited information on the patient’s health history (electronic medical records are still TERRIBLE). THAT is the environment that ED providers operate in.

…this is not a miss that an emergency physician is going to get an “oh, well, sometimes we miss things” pass on. Apparently, their specialty is ruling out uncommon but very bad things, and this is a very bad thing that the standard of care required to have ruled out, particularly considering the duration of the condition. It doesn’t help the looks of things that they decided not to start an IV only because they couldn’t succeed in starting one. In other words, this was not a patient who came in, left against physician advice, and now doesn’t want to pay for being seen. Yes, hospitals go after patients like that with both guns blazing.

This is absolutely a “miss” that emergency providers CAN get an “oh, well, sometimes we miss things” on. Intususseption is a very rare disorder, and rarely presents itself in a typical manner (currant jelly stools). The vast majority of the time the initial presentation is like colic, gastroenteritis, teething, constipation, etc. Intusussception can be transient, meaning it comes and goes. Furthermore, the diagnostic testing for it is frequently not available at smaller EDs, so requires transfer to tertiary care (pediatric hospital).

So, you have a kinda-sick kid (the kind you see 2-3 of every shift) who is fussy…are you going to ship 1000 of those kids to the pediatric ED just to catch the ONE kid who will have intusussception? Parent’s won’t be happy with those 1000 ambulance rides that turned out to be for a stomach bug.

The “decision not to start an IV” is not well described here. Again, I’ve ordered IV fluids on kids, only to change my mind because of very difficult sticks and the kid is getting oral fluids (nursing). It’s not always unreasonable, but certainly should be carefully explained in the provider’s notes.

I’ve never known of a hospital who “went after patients with guns blazing.”

Sorry, just reading your post here.
there is ultrasound guidance to start a peripheral line, also other ways to access such as a PICC line. it is considered-- in every standard of care for ( in this case a toddler) to have repeated IV attempts such as the mother described. its abusive… because there are alternatives.
also there are volumes written on this very subject if you are interested through google search or library.

I’ve never seen a PICC line inserted in the ED. If I NEED access I will use an IO, or a central line if I need better access.

Also, ultrasound an be used for peripheral IVs as well as central lines, but you gotta know what you’re doing.

Multiple IV sticks are not abusive.

I believe after 3 attempts the protocol is to bring in a phlebotomist (sp?) / lab tech

Phlebotomists will draw blood, but can’t insert IVs, IOs, PICCs, or CVLs. Most hospitals have a “3-stick” rule for the nurses, where an individual nurse can try 3 times before they call another nurse or provider. I’ve seen absolutely AMAZING nurses fail three times, only to have the worst nurse in the hospital get it on the 4th attempt.

And, like I described above, PICC lines are not inserted by ED teams. And IOs/CVLs are reserved for the truly sick patients who need resuscitated RIGHT NOW and we can’t get peripheral IV access.

I am very glad that your daughter is okay, and it sounds like it was caught early enough that she didn’t need surgery for a necrotic bowel. I hope you are able to get the hospital to waive their charges. Please keep us posted.

 

[Melissa]

I work in a hospital (I’m in insurance follow up, making sure the insurance companies pay correctly), but I also know that there is a system in place in my facility, and probably many others that is fairly easy to use for registering a complaint.

Our system is called OFI (opportunity for improvement–gotta love corporate-speak), and it starts with a call/letter to someone at the front-end customer service. Basically, you give the outline of what happened, how you want to be contacted (our system allows for phone calls back, letter, or email), and what sort of resolution you want. These things are taken very seriously … once it’s entered into the system, it kicks up to someone in senior management/administration (that depends on the specifics of the complaint), and they have 48 hours before they’re supposed to make their first contact. It’s not necessarily resolved at the first contact, but it’s usually kicked up to someone who can actually do something (authorize a bill reduction, up to a full write-off, for example).

 

[Allegra]

I agree with this advice. I can’t imagine a hospital being unable to get an IV in a child, although an IV wouldn’t have solved the problem. And the misdiagnosis might have been fatal, as someone mentioned.
At least I would expect them to cut the bill in half.
I had a doctor order a CAT scan but forget to get pre-authorization, so they billed me for a $4000 procedure. The doctor ended up splitting the cost with me.
If they won’t budge, I suggest consulting an attorney; many will do a free 15 minute consult.
So glad your baby is all right.

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I can totally imagine a ER not being able to get an IV in, particularly if they didn’t have a specified pediatric nurse to try it. Children’s blood vessles are small anyway and being dehydrated and stressed out makes the job even harder. I am an adult and I’ve been told by ER nurses that an IV was absolutely necessary for my survival and then when they couldn’t get it in, told to go home. Some of these ER people are just not very good phlebotomists.

That being said, I would definitely not pay the bill without a fight. We had an instance where my daughter was injured by some sort of intern putting in her breathing tube during a surgery. Her surgeon noted that there was some bleeding and they had used the wrong size of tube initially. No one said anything to me about this when they came out of surgery and when we got home, she suddenly started breathing like Darth Vader. We took her to the emergency room and they gave her a breathing treatment. The records didn’t show the name of the person who put the tube in, but her surgeon knew the person whose name was on the record and insisted that it was not that person that he saw putting in the tube. When I told him what had happened, he called hospital administration and reported the incorrect record keeping and the injury to my daughter. They wrote off the entire ER visit, which was good because the insurance company sent a letter a couple days later saying that they weren’t paying for the hospital to treat an injury that they caused. If you submit your record from the hospital that actually treated your child, you can show that the ER didn’t do their job correctly. If you talk to the right person, it may work out! Insurance companies are getting kind of fussy about paying for the hospital’s mistakes.