Thinking About Health: Insured victims of medical errors can get big bills
September 25, 2015
Last winter Tammy Fogall, a reader in Colorado, told me about her family's "troubled summer vacation," as she called it. A visit to relatives in Ohio had turned into a medical nightmare that left the family struggling with a $12,000 bill plus a ringside seat to observe what happens when doctors and hospitals make mistakes.
Shortly after they arrived in Chillicothe, her 43-year-old husband, a retired Army National Guard staff sergeant, suffered a burst appendix that neither doctors at a local VA clinic or a small regional hospital where he was sent diagnosed correctly.
He languished for eight days as his belly swelled with pain and he was pumped full of antibiotics. On the eighth day doctors sent him home to Colorado with instructions to follow-up on what they concluded was a virus in his small intestine. A day later he was whisked into surgery. He almost died. When the Colorado doctor learned Fogall had been given antibiotics, he told his patient those drugs had masked symptoms of the diseased appendix. Without them he might have had surgery sooner.
Eventually Fogall made a full recovery. "I now have a $12,000 hospital bill, and I'm responsible when the hospital screwed up," Tammy Fogall said.
The Veterans Administration covered their Ohio medical bills while a Blue Cross Blue Shield plan from her husband's employer paid for most of the Colorado hospital's $75,000 bill. What they still owe is the result of a $4,250 deductible and the requirement to pay 20 percent of their remaining bills after satisfying the deductible.
Fogall, who sells ads for the Colorado Springs Business Journal, pays the hospital $100 a month. "That's all I can afford," she said. The hospital has sent the account to collections.
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Like most victims of medical errors, Fogall consulted several attorneys — 20 or so by her count. They all said it would cost more to fight the hospital than pay the bill. Her case was too hard to prove, they told her.
I rang up Helen Haskell whose son died from a medical mistake in a South Carolina hospital many years ago. Since then she has founded Mothers Against Medical Error to provide resources and advise families whose loved ones have been hurt by the healthcare system. Each year hundreds of thousands of Americans are harmed although no one knows the precise number.
Haskell says the legal system "exists for large claims, those involving hundreds of thousands or millions of dollars," and that puts people like Fogall in a bind even when their claims are justified. She added if the hospital has no interest in "doing the right thing," there's little the family can do.
Still, families can take certain steps when a loved one has been harmed. These include:
• Getting copies of the patient's medical records as soon as possible after the incident. That means doctor and nursing notes, lab results and digital imaging studies.
• Making sure the incident is reported internally. Accredited hospitals are supposed to conduct a review called a root cause analysis and implement procedures to prevent harm. Try to have your version of events made part of the review.
• Ordering a forensic autopsy if the patient has died. Hospitals don't routinely conduct them, but Haskell says the family always has the right to have one.
• Considering calling an attorney even though the odds are against anyone taking your case. But an attorney may help you negotiate with the hospital.
• Meeting with hospital officials and the doctor. Talk to them about how they will learn from the incident to prevent harm to other patients. If your family member has suffered a disability or has died, try negotiating with the hospital to see if it will waive medical bills or negotiate a reduced level of compensation.
• Reporting the incident to regulators who can investigate and penalize healthcare providers. Contact the state health department; your state's state licensing boards for doctors and nurses; the Joint Commission, which accredits hospitals; Medicare or one of Medicare's Beneficiary and Family Centered Quality Improvement Organizations.
Fourteen years ago the Joint Commission announced a patient safety goal for hospitals: They should disclose "unanticipated outcomes" or medical harm to families. Studies show that when hospitals meet with families and apologize for their mistakes, families are more able to move on and reach a settlement. When medical providers circle the wagons, it's another story.
Hospitals know what they are supposed to do, Haskell said. "But so far most are not doing it."
Have you or a family member experienced a medical error? Tell us about it. Write to Trudy at email@example.com.