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From: B. Harris)
Subject: Re: The Patients' Bill of Rights (was Backlash against HMOs: a 
	declaration of war)
Date: 13 Apr 1999 01:35:16 GMT

In <7esi5c$7tr$> (George
Conklin) writes:

>   Community hospitals do a heavy load of charity care yet
>do not get the Medicare money at all.

    What universe do you live in, George?  The only charity care
community hospitals do is ER care that they are forced by law to do.
They transfer stable indigent or poor non-insured non-medicaid patients
to county hospitals as fast as they can.  And not a few close their

From: B. Harris)
Newsgroups: misc.consumers,misc.consumers.frugal-living,talk.politics.medicine,
Subject: Re: Disappointed and confused--don't know what to do
Date: 24 Apr 1999 09:05:43 GMT

In <> Bret Wood
<> writes:

>"Steven B. Harris" wrote:
>>     I consider that every citizen is protected by medicaid as the
>> ultimate medical insurance backup, if they cannot pay out of pocket.
>You didn't say protected, you said COVERED.  And that is a bald-faced

    Semantics.  If you want to argue that being legally entitled to
benefits if you must have them and can't do it yourself, does not count
as actual coverage, be my guest.  It quacks like a duck to me.

>Anyway, there is more to qualifying for medicaid than just a minimum
>asset level.  Many people who have jobs which don't include insurance
>would have to quit their job in order to qualify.  Most married
>couples can NEVER qualify unless one they get divorced, or one of
>them is disabled.  Single men (to the best of my knowledge) don't
>qualify unless they can get on SSI, which requires at least a
>year of disability before they will even accept an application.
>And then you need to be on SSI for ANOTHER year after your acceptance
>before medicaid kicks in.  I guess if you become disabled, and lose
>your job and your insurance, you CAN get medicaid.  As long as you
>can wait TWO YEARS for the damn insurance to kick in.
>Your dishonesty is rising to the level of your arrogance.

    This is a country where poor women take their kids to the local ER
for the sniffles.  And the local winos go there too, when they fall and
get cut.  All are treated.  I've been there and watched it.  And done
it-- I once, at Orthopedic Hospital in Los Angeles in 1986, was
moonlighting in the little ER when two victims of a driveby shooting
were dropped off by gang members who didn't know we weren't a big
trauma center, and didn't really have facilities to treat two young men
with their faces full of shotgun pellets, and both (needless to say)
blind.  The kind who are supossed to be dying on the street outside,
remember?  After the orthopedic resident and I trach'ed one drowning
guy while he coughed blood in our faces, we called "Big County"
hospital (LA County at USC) to take them.  "Are they stable for
transfer?"  "Hell no, they're not stable for transfer! That's why
you're taking them!"  They took them.  Any ER in the country has to sit
there and take it, though most don't have the luxury of transporting
unstable patients, as we did.  Which is part of why your hospital bill
is so high.  Which is part of why you are now uninsurable.  In a sense,
you are arguing that we have the system which already exists, and which
is responsible for problems which want you to change the system to be
even worse.  As I've said, you've shot yourself in the foot on that
one.  I suggest a visit to an ER.

                                     Steve Harris, M.D.

From: B. Harris)
Newsgroups: misc.consumers,misc.consumers.frugal-living,talk.politics.medicine,
Subject: Re: Disappointed and confused--don't know what to do
Date: 24 Apr 1999 09:37:58 GMT

In <>
(Karen Wheless) writes:

>> One way or another, people who need medical care badly will get it.
>> Nobody lies in the street and dies. It's just that you can't get
>> really expensive medical care and own a lot of stuff, and keep it,
>> unless you join a risk-pool. But I fail to see why you should.
>But the treatment you get isn't the same. There have been studies that
>show that, for two patients with the same illness, the uninsured patient
>is more likely to die, and is more likely to receive less aggressive
>treatment, and is more likely to end up with long term problems. (Sorry,
>don't have the exact cite.)

    Yes, you are correct.  The treatment the "uninsured" get at the
expense of your government (or your own insurance program, if they go
to the ED of a private hospital) is not convenient, and sometimes
not that good.  Although it can be far better than in most other
countries.  In one county hospital, "Harbor General Medical Center"
(Torrence) where I rotated during my residency, I saw some top notch
medical stuff being done on people who were dirt poor.  One guy I
remember had wrecked his heart valves with IV drug use, not once, but
twice (seeding the artificial valve the second time).  They took him to
heart surgery and replaced THAT one.  God knows what all this cost the
California/LA taxpayer-- I don't even want to think about it (actually,
the taxes were so high in California that I really don't want to think
about it).

   Harbor General was an interesting place, with echos from WWII and
19th century endocrinology.  When I was there, the back parking lot was
filled with genuine wooden barracks, in which the most amazing research
was done.  The entire U.S. supply of human growth hormone came from
there until about 1985, with pituitaries from tens of thousands of
cadavers funneled into this little lab with high security in this
grungy old building, run by one of my profs.  Where it was extracted
like something out of Frankenstein or one of those old 50's sci-fi
movies, where the anti-aging potion is made from pituitary and Sacred
Nipe Root.  Ended up giving a few people CJD (much like mad cow
disease) before the thing was shut down.  More sci-fi, but real.  The
remaining kids were saved from migethood by genetic engineering, which
arrived in the nick of time.  Even more sci-fi, and also real.

                                      Steve Harris, M.D.

From: (Carey Gregory)
Subject: Re: Medical denial is it really a problem?
Date: Fri, 07 May 1999 16:52:23 GMT

Bret Wood <> wrote:

>I am getting REALLY pissed off at people using psychiatric labels just
>because they don't believe someone else.

Get a grip, Brett, or someone might apply a psychiatric label to you.
Quite frankly, there's probably no one who cares if you're REALLY
pissed off.

Furthermore it isn't an issue of believing the man.  Like him, you
seem incapable of reading what was written instead of reading what you
want to hear.

>And by the way, it appears that you are full of shit with your claim
>that "no hospital would dare risk it knowingly."  (And no, "full of
>shit" is _not_ a psychiatric diagnosis, merely an insult.)

No, I don't think I'm full of shit, but you're free to prove
otherwise.  Jumping in with childish insults and 10 whole seconds of
research is a great start.

>I just did a 10 second search on the web, and it was trivial to
>find an article on the issue.  If you want more information, do
>the research yourself.

Yeah, the full 10 seconds you spent shows... 10 second of research and
you're a friggin' expert ready to declare people full of shit.

Did you notice that when you click on the link to view the full
report, it's mysteriously unavailable?  Did you also notice that the
*raw* numbers they cite are trivial and they offer no comparison or
trend data?  Did you notice the report is two years old?  Did you
notice that the editorial opinions of the authors are quoted without
supporting references or data?

Maybe you should go find the source material and read the facts.  From
what I've seen, you're likely to find that some were legitimate
decisions to send patients to more appropriate facilities, some were
bureuacratic snafu's, and some were probably ridiculous cases of
federal bureaucrats making inappropriate decisions and fining
hospitals for doing what was in fact the best course of action for the
patient.  And yes, some were probably legitimate cases of dumping, but
the web site gives no way to find out and no supporting basis or trend
data to examine.

Let me give you a real life example of federal bureaucracy in

A man was very seriously injured in a car accident two blocks from a
community hospital.  Paramedics at the scene requested a medevac
helicopter to transport him to the regional trauma center some 20
miles away (smaller hospitals do not have the staff or facilities to
handle serious trauma, and taking him to the community hospital first
would be highly detrimental).  However, the community hospital did
have a helicopter landing pad on the grounds, so the paramedics used
it to land the helicopter and make the transfer.  The hospital was
subsequently fined $50,000 for "dumping" the patient.  Because the
patient physically arrived on hospital property, federal rules said he
had to be evaluated and stabilized before being transferred.  However,
to have done so would clearly have been detrimental to him, and he
likely would have died due to the delay.  In their infinite wisdom,
the feds would not have taken punitive actions had the man been taken
to the community hospital and died there in their emergency room for
lack of a trauma team.  That would have been perfectly fine with them.

This case would be included in the stats.  Do you think it should be?

Now, please go back and do more than 10 seconds of homework.  Read the
*full report* and learn how these things work before getting your
panties in a wad and bandying about insults and diatribes.

Carey Gregory

From: B. Harris)
Subject: Re: Medical denial is it really a problem?
Date: 8 May 1999 01:05:34 GMT

In <> (Carey
Gregory) writes:

>No EMT or paramedic I've ever known thinks that.  If there's anyone
>out there who understands the difference between hospitals when it
>comes to trauma, it's EMT's and paramedics.

   Yes.  Your EMT story now makes much more sense.  In my case, of
course, it was the guy's friends who had dropped him off.  But that's
no small part of the patients which smaller hospital EDs are forced to
transfer immediately.  The guy with the sucking-chest GSW who gets
dropped off by "friends" who then disappear is a classic example.
Surprise, such people tend to have no insurance, and a surprising
fraction are of some minority group (whatever your local subculture
happens to be).  That always makes it look like discrimination, or
transfer of someone unstable for economic reasons.  Usually, it isn't.

From: B. Harris)
Subject: Re: Medical denial is it really a problem?
Date: 10 May 1999 05:14:53 GMT

<0D4D5E77E137D8E9.FCE148E1AB5B8EA2.A27A263B9883A025@library-proxy.airne> (Jonathan R. Fox) writes:

>So, therefore, in your opinion, private hospitals should not transport
>patients to other hospitals for admission for financial reasons, even
>if they are appropriately evaluated and stabilized?  Private hospitals
>should be required by law to admit them?  And then have to close due
>to all the unpaid bills?  Then there would not even be the private ER
>there anymore to evaluate, stabilize, and transport the patients after
>that.  Just an empty lot.  Sounds like you'd be doing more harm than
>good in the long run.
>Jonathan R. Fox, M.D.

   Indeed, this is exactly like minimum wage.  Raise it too high and
there are no jobs to be had-- the law of unintended consequences.

    There are now laws against congress laying taxes without calling
them taxes, by means of unfunded mandates.  If, instead of providing
money for local ERs to care for indigent poor, the government simply
requires them to, that's a classic unfunded mandate.  It's no different
than laying a special tax on hospitals for maintaining an ER (ED),
which monies congress then for indigent medical care.  Not a tax on
wage earners generally, but a specific and local tax on hospitals.
What does everyone think the result of such a thing will be?  If I put
a heavy tax on your business to do something you can possibly get out
of doing, what do you think you're going to do?  The idea behind
no-dumping laws is that the average bunch of hospital owners are far
too stupid to do what any dolt would do, which is to shave that part of
the business off and let it be somebody else's problem.

    I wonder what people can be thinking?  If a city decided to get rid
of its hunger problem by simply requiring that every restaraunt feed
anybody who walked in, regardless of ability to pay, how many
restarants would such a city have, five years later?  It should be
fairly obvious.  But why is it that people seem blind to the problem
when it occurs in medical care?

From: (Carey Gregory)
Subject: Re: Gregory demonstrates that Medical denial is a reality!
Date: Sun, 16 May 1999 23:48:30 GMT

Bret Wood <> wrote:

>Although I haven't heard Mr. Gregory specifically state what his
>occupation is, based on hints he has made, I believe he is either a
>paramedic, an EMT, or an ambulance driver.

FYI- There's no such thing as an ambulance driver, and the term is
considered derogatory.

Since you wonder, I'm an EMT-I (never mind exactly what that means),
chief of EMS for a small fire/EMS department, and a few other things
not very pertinent to the discussion.

>It would explain his view of ERs, because AFAIK, it's not very often
>that an ambulance pulls up to an ER, and the occupants are asked to
>wait for 4 hours, or asked if they have insurance.  :)

Nice try, but you're quite wrong.  The only difference between a
patient arriving by ambulance and one walking in the door is that the
ambulance patient has already been assessed and treated and a report
has been given to the ED staff.  If their condition is truly serious,
most interventions that can be done in the ED have already been done
by the ambulance crew.  If they're not serious, then the ED staff
knows that in advance and they'll be shuffled off to the waiting room
along with everyone else who isn't currently dying.

Whether they have insurance, or whether they can even answer the
questions doesn't change the treatment they receive or the order in
which they're seen.  Their medical condition determines that.  It's
called triage, and insurance is not a factor in the triage process.

It's not unusual for ambulances and emergency rooms to not even be
able to identify patients, much less find out if they have insurance.
It doesn't alter the care they receive, and if you knew how often that
happens, how often we work our butts off for people we don't know one
thing about, you'd understand why I get a little irritated with these
baseless claims to the contrary.

In fact, the first day this post appeared I had spent an hour on the
phone that morning trying to track down the next of kin of a gentleman
who had the misfortune of having his heart stop while walking down the
street.  He could have been a millionaire or he could have been a
homeless wino.  We had no clue and it didn't matter at the time.  IT
NEVER DOES.  I assure you this man got one hell of a lot of time,
effort, sweat, and expense.  All we knew was he was somebody's father,
grandfather, uncle, teacher, brother... and he got exactly what you or
I or Jim or Steve Harris would get, and this happens every single day
all over the country, and it happens the same way every time.

So maybe this will help you understand why it pisses me off just a
little to see ignorant, blatantly false claims being bandied about by
those who obviously do not know what the hell they're talking about.

Now, if you'd like to talk about the huge problem of patient abuse of
ambulances and emergecy rooms, we can talk about that.  Unlike the
claims in this thread, this problem is well documented and costs
taxpayers millions every year, and more than a few patients their
lives due to resources being tied up by patients who have no real
emergency.  Oh yes indeed, you should see what comes in the emergency
room.  Please do educate yourself by volunteering a few nights at the
local hospital.

Carey Gregory

From: Carey Gregory <>
Subject: Re: Gregory demonstrates that Medical denial is a reality!
Date: Mon, 17 May 1999 06:43:02 -0400

Bret Wood wrote:

> I was generally under the impression that most people who went to the
> ER by ambulance were in serious condition.

It would be nice if that were true.  In most urban areas abuse of 911 and use
of ambulances as "free" taxis is a big problem.

Question: How to get across town in a hurry if you're broke and have a
medicaide card?

Answer: Call 911, report difficulty breathing, fake it for 10 minutes, and
then walk out of the ER you were just deposited in at taxpayer expense.

Yep, people really do that.  In areas like where I live, we don't encounter
that sort of flagrant abuse much, but a large percentage of ambulance calls
are still people who (reasonably) *thought* they had an emergency.
(Meanwhile, the real emergencies are driving themselves in, gasping for air
all the way, because their HMO phone nurse told them to "go to the emergency

> No one claimed that any of the hospitals YOU work with are engaging
> in patient dumping.  You haven't offered any evidence beyond your
> own experience.  Yet you have gotten _really_ rude at points in
> this thread.  I did give a post with two links, one to reports on the
> increasing numbers of reported cases of patient dumping, and to
> the fact that very few of the hospitals involved are sanctioned beyond
> a small fine.  That report even listed specific hospitals and instances.
> The second link was to a court case where a person was shuttled between
> hospitals until they died, because their HMO was only valid at certain
> ERs.  In that case, the doctors involved said that they WANTED to treat
> the patient, but hospital policy forbid them.

If I've been rude it's because I have repeatedly acknowledged that patient
dumping happens, only to turn around and have that acknowledgement ignored and
find myself accused of complete denial.    Yes, what I've offered you is
primarily personal experience, but it goes along with the experience of dozens
of other medical professionals I know around the country.  Patient dumping in
the ED is a major taboo everywhere in the US.

Now, as for HMO's and the abusive practices of the insurance industry, that's
a much different issue, and you'll find very little disagreement from me on
that subject.

> Patient dumping happens.  It is NOT epidemic.  But it does happen
> more than just 2 or 3 times per year.  The theoretical risk for
> a hospital is very large, but the actual penalites which are
> levied are much smaller.  And solid data is hard to get because
> legal settlements are usually accompanied by gag orders.

Yes, patient dumping happens.  The instances are a tiny fraction of all cases,
and I believe the cases of truly intentional dumping are a tiny fraction of
that number.  As I said, I've never disputed that it happens.

As for gag orders, federal actions taken against hospitals are public

> I'm not trying to act like a crackpot here.

And I appreciate that.  Sorry if you're catching flak invoked primarily by
someone else.

Carey Gregory

From: David Rind <>
Subject: Re: Naughty Doctors
Date: Fri, 02 Jul 1999 17:00:33 -0400

Carey Gregory wrote:
> No.  As a matter of fact, doctors are usually discouraged from
> accompanying the patient in an ambulance.  He can if he insists since
> it's his patient, but except in very unusual situations there's
> nothing he can do that the paramedics can't, and he's unlikely to be
> familiar with their equipment, protocols, and procedures.

Yes, these situations can get really tricky.  I'm trained as
an EMT (long ago) and saw how unhappy EMTs and paramedics were
to have any interference from MDs on the scene.  I've also been
an MD on the scene and watched ambulance personnel do everything
they could to pretend I was not there.  I've also watched them
do things that were clearly medically inappropriate (e.g. give NTG
to a hypotensive patient whose problem was COPD) which I would have
tried to stop, but instead figured it was safer to just let them do
what they wanted rather than cause an argument at the scene.

It's hard for the paramedics and EMTs because they have no clue
who to trust, and it's hard for the MDs when they are in a
situation where they are in fact better trained and may actually
be legally liable if they permit inappropriate care.  Also,
in my experience, EMTs and paramedics have a lot of ego tied
up in believing that MDs are idiots who don't have a clue how
to manage patients in emergencies.

As a result, despite my EMT training, my medical training, and
two years of moonlighting flying on a medical emergency helicopter,
I hate stopping at emergencies to offer assistance.

One other point about accompanying patients in ambulances: I'm
convinced that riding in the back of an ambulance, unrestrained,
as it speeds around corners, is quite dangerous.  I felt
much safer doing helicopter transports than ground transports.

David Rind

From: (Jonathan R. Fox)
Subject: Re: Naughty Doctors
Date: Sat, 03 Jul 1999 23:22:26 GMT

On Sat, 03 Jul 1999 13:51:25 GMT, (Kurt
Ullman) wrote:

>In article <>, Edward Mathes
><> wrote:
>>They also mentioned that, to turn a patient over to a person of lessor ability
>> (ie PA to EMT) is also considered abandonment.
>        That is BS. Besides you are not turning over to EMT, you are turning
>over to the base hospital. That is well established through case law in most,
>if not all, states. Even EMTs are under the control of the emergency

What does "under the control" mean?  The EMTs have the ability to
operate independently in their decisions and actions.  And does this
apply to liability as well?  Recently, some dipshit EMTs here in my
town delivered a two-year-old girl who was unrestrained in an MVC and
had a broken femur.  She rolled in curled up in her mother's lap with
the EMT walked along side them putting manual traction on her leg.  I
was already annoyed at yet another avoidable trauma due to the
mother's stupidity for not restraining her child properly ("I was only
going a few blocks!" she said), when I said to the EMTs, "Why isn't
the kid in C-spine?"  The EMT said, "Oh, she was fighting us too

It wasn't so much the fact that the two adult males weren't too
embarrassed to pretend that they couldn't control a toddler when it
comes to protecting her neck, and thus possibly her life, rather than
admit their real reason for not controlling her C-spine (which I will
never know), but what about the fact that now they've delivered this
improperly stabilized patient to us, and it becomes our responsibility
if something has gone wrong?  What more can we do except document in
the medical record that the child, whose body was made into a
projectile with enough force to break her leg, was deemed not to have
a broken neck by the EMTs and thus the standard of care was not

Jonathan R. Fox, M.D.

From: "Steve Harris" <>
Subject: Re: Unsafe At Any Illness
Date: Tue, 1 May 2001 12:20:47 -0700

Dilworth wrote in message <3aeefd9e$0$88188$>...
>That doesn't mean that insurance companies pay that much.  Hospitals
>make deals with HMO's and insurance companies to only pay so much for
>each test and have discounted fee schedules, depending upon utilization
>and a number of complicated factors.  The unfortunate people who have no
>insurance bear the brunt of the charges.  It's terrible.

It's terrible, but you're exactly wrong. People with INSURANCE bear
the brunt of the charges. People with no insurance simply don't
pay their hospital and ER costs, and that's the end of it. These costs
are passed on to those who have a health plan. Your HMO. Your
employment insurance.

Imagine if hungry people could enter any restaurant they
liked, eat, and have the bill presented to the people at
the next table. Now you get some idea of how our medical
system works.

I'm not talking even about starving people. Most "indigent"
people who use ERs are not dying. Most have cars,
color TVs, and a freezer full of microwavable
stuff. A fair fraction live in houses, not even rented
apartments. Welcome America, land of affluence.


From: "Steve Harris" <>
Subject: Re: Unsafe At Any Illness
Date: Tue, 1 May 2001 15:19:50 -0700

Don Stevens wrote in message <>...
>I took my wife to the ER back in Jan., as a old med tech that was use to a
>$3.00 urinalysis the following charges really bent me out of shape and
>ALMOST!!!! made me want to go back to work.;
>Comp Metablc Pn, --$263.00
>CPK Total-----------------162.00
>CBC/Diff& Platelet -----114.75
>Prothrmbn Time--------- 131.50
>PTT, Plasma -------------  131.50
>EKG ---- --------------------  375.00
>Glucose, Bld  STK ------  153.50
>Now, somebody makes one hell of a profit on the above.

Particularly the last item. A fingerstick blood glucose. What
the average diabetic does twice a day. Nurse comes in,
pricks your finger, puts blood on a little dipstick, sticks
it in a $79 machine.  Number pops up.  For this you pay
more than an entire Q-lube oilchange.

It's cost-shifting, of course.  The single greatest source
of evil in the world is systems in which feedback
loops have been broken, so there's no feedback information,
so there's no incentive for the system to get better, and every
incentive for it to go to hell. In this case the feedback loop is
fee for service.  The hospital would charge you the market
cost, but it's ILLEGAL for them to do so. By which I mean,
the laws are written so that if they actually did charge market
rate to everybody and refused service to those who couldn't
pay, they'd be shut down.

If you want to see something approaching fee-for-service
medicine, see your local vet. And even there you're paying
a high regulatory overhead.


From: Norman Yarvin <>
Subject: Re: Unsafe At Any Illness
Date: 3 May 2001 21:37:16 -0400

In article <9cncrc$qal$>,
Steve Harris <> wrote:

>Don Stevens wrote in message <>...
>>I took my wife to the ER back in Jan., as a old med tech that was use to a
>>$3.00 urinalysis the following charges really bent me out of shape and
>>ALMOST!!!! made me want to go back to work.;
>>Comp Metablc Pn, --$263.00
>>CPK Total-----------------162.00
>>CBC/Diff& Platelet -----114.75
>>Prothrmbn Time--------- 131.50
>>PTT, Plasma -------------  131.50
>>EKG ---- --------------------  375.00
>>Glucose, Bld  STK ------  153.50
>>Now, somebody makes one hell of a profit on the above.
>Particularly the last item. A fingerstick blood glucose. What
>the average diabetic does twice a day. Nurse comes in,
>pricks your finger, puts blood on a little dipstick, sticks
>it in a $79 machine.  Number pops up.  For this you pay
>more than an entire Q-lube oilchange.

I had a short trip to an emergency room about two years ago, which
involved about two hours' stay, an EKG, and about a liter of IV saline
solution.  (I'd fallen down and hit my head, after IV Versed for removal
of wisdom teeth.)

The first bill from the hospital was about $500.  ("We are submitting
this to your insurance company...")

The second bill was about $85.  ("...charges reduced by prior agreement
with insurance company.")

My guess is that this means that besides the rate insurance companies
normally pay (this was Blue Cross/Blue Shield), there is an even higher
rate, which gets paid by out-of-state insurance companies, or other
entities with deep pockets and no prior agreement.  And this is the rate
that gets quoted first.

Norman Yarvin

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