I don't care how 'exceptional' they say our hospitals are....

[Avalux]

the ability to pay has an impact on how a patient is treated.

Eric Duncan, the now infamous Ebola patient, is a non-US citizen from Liberia with no insurance. He walked into that ER in Dallas with flu-like symptoms and because he wasn't suffering a cardiac event or severe trauma, they got rid of him as soon as possible since he couldn't pay.

All they wanted to do was free up the bed for a paying customer.

Such is the reality of for-profit hospitals.

[LanternWaste]

1. I hadn't thought about it prior to this, accepting that a foul-up is a foul-up is a foul-up

I hadn't thought about it prior to this, accepting that a foul-up is a foul-up is a foul-up. But yeah... for-profit medical centers to want to clear out the non- and under-insured as quickly as possible to make more room for the board's Christmas bonuses.

I'm hoping this was merely a procedural mistake and not indicative of this larger problem you point to.

[Daemonaquila]

7. No, the OP is right.

I do disability law. I read thousands upon thousands of pages of hospital and ER records every year. Every month, really. The verdict is that the OP is right - your insured status has EVERYTHING to do with how you are treated. Granted, some hospitals will do their best to kill a person anyhow, but the uninsured or poorly insured are regularly treated to a "catch and release" system that sends them home in dire condition, or at least in soon-to-be dire condition. I've had them try to send home a client in diabetic crisis, going into sepsis. Another client was sent home with a shattered hand from a gunshot wound, untreated, the wound not even cleaned out, no antibiotics, just instructed to go find a hand surgeon in the morning to deal with it. I've had a client who had just been released from the hospital after a month of evolving strokes, show up in ER with full hemiparesis only to try to send her home with a grandkid, saying "Oh, it's really easy to care for a paralyzed person. You'll manage." The stories I could tell go on and on. I've got bad ones about insured clients. I have unspeakable ones about uninsured or county health care clients.

[cali]

11. I feel so lucky that as an uninsured person

I got terrific care and was treated with nothing but kindness and respect. Then again I arrived by ambulance with a shattered (and I do mean shattered) leg- and I live in Vermont. I've never heard a horror story like the ones you recount-and I'm sure they're true- here.

[valerief]

2. And even though he knew he might have been infected, he could have thought,

'They're not keeping me, so I must be okay.'

[Avalux]

3. Sure. We don't know his background; how informed he is.

Being a Liberian citizen, perhaps without any medical knowledge, he may have no idea how serious the situation was. So when he goes into an ER is the United States and is told to go home and takes some pills, what else is he supposed to do?

[Warpy]

5. They probably looked at the "uninsured" on the paperwork

and discounted his country of origin and symptoms.

You'd be surprised at how being uninsured will keep you out of the hospital when you would have been admitted quickly had an insurance company name appeared on the paperwork.

[Avalux]

6. Question to ponder: Is it possible the nurse didn't know where Liberia is?

I wonder. The breakdown occurred (per the hospital), when the information didn't get relayed from the nurse to the treating physician. Why? Did she not think it was important enough to write down because she's geographically challenged?

[Warpy]

9. Or the doctor. One Harvard Medical School resident asked me

what kind of visa I'd need to move to New Mexico. I kid you not.

However, Liberia has been in the news as an ebola hot spot and in the medical literature that ER docs use as bedtime reading so there is not much of an excuse there. Even if they had no clue what continent the city of Liberia was in (heh), they should have recognized the name.

My guess is that they didn't want another uninsured patient in the hospital.

[Daemonaquila]

12. Here's how this usually works...

The guy gets triaged and the intake nurse may or may not have entered the information into the electronic record. Chances are she did, if she asked or he volunteered the information.

He gets put into a room, and he waits. And waits. A nurse - who probably has never read more than his name and a line of his problem - comes in per the routine to put an IV cannula into his arm in case they might need to use it. She's there to do that one task, not ask questions or care for the patient unless she walks in on something dire.

Then he waits some more while more worrisome cases get treated. One or more nurses might come in to take his BP or temp, if the nurse didn't already do that on intake, and to reassure him that someone will be coming to see him. Eventually.

Finally, a doc comes in. He has probably read the patient's name and a few lines of the description. The full intake record? Quite doubtful. He has probably already made up his mind that this is another uninsured dude clogging up their ER with a run of the mill virus. He might not bother having any blood testing done - after all, the guy can't pay and why waste time and money running a basic panel that will just show that yes, indeed, his WBCs are down... it's some virus or another.

Their job done (making sure that the patient is stable enough to release, NOT actually doing something to better diagnose or treat a sufficiently stable patient), his file is passed on to nursing staff to get him out of there with the standard printed instructions on how to drink liquids, etc. with a virus. Maybe he gets a prescription for antibiotics (if the doc was covering all bases) to take home. Out with you!

And that's it. The doc and most of the nursing staff never really talk among themselves. It's just another mild case of something wasting their time, and they're going to do the minimum before getting on to the next patient.

[Warpy]

4. The buildings and the equipment are often top notch

but decades of short staffing will make the holes in the system rather glaring in the not too distant future, I'm afraid.

[ksoze]

8. The Drs did not have the needed info

The fact he came from west Africa recently was not noted for the caretakers. Without that critical info, it looked like he had a virus or flu and was given anti-biotics and released. That would have happened to anyone with insurance, happens all the time.

[magical thyme]

13. this ^^^^ makes the most sense to me. nt

[Catherine Vincent]

10. I agree with this

It makes a lot of sense.

[CanonRay]

14. Exactly right

They'd dump a hundred Ebola patients on the street if they thought it would cost them a dime.

[Horse with no Name]

15. I will say that you are correct in most cases

but Presby Dallas pretty much takes everybody, regardless of ability to pay. The triage was appropriate at the time.

They are not-for-profit hospital.

Dallas has a fairly large African population, so that wouldn't have been a factor.

Edited to add:
There are numerous nurses that work in Dallas from Africa and all over the world that are here on work visas. It would shock me to find out that he was turfed out because he was from another country.