Uninsured in America

[Horse with no Name]

We got a call earlier today. My 48-year old brother-in-law went to the hospital last night because he was having trouble breathing.
He hasn't been taking his blood pressure medications because he lost his job and doesn't have any means to afford it. Of course, he didn't tell anyone this until this week when he started feeling bad.
Talked to him a couple of nights ago, said his feet were swelling. Tried to persuade him to go the ER, he said he would.
But...he didn't. Until last night.
Talked to the hospital Social Worker this afternoon...she said she would work to get him on the county indigent care rolls so that he could be on the track to get Medicaid.
Talked to the nurse. Said he was feeling better. Blood pressure was under control. He was talking. Feeling better. But...because of lack of medication and out-of-control blood pressure, there was liver and kidney damage. Cardiologist couldn't do tests because kidney function was too far down.
Get a call later tonight...he apparently arrested at 6:30 tonight.
They got him back, but he is posturing and pupils are pinpoint and non-reactive and he is on a ventilator.
They asked if we wanted to make him a "DNR".
At this point, we said no. The neurologist is scheduled to see him in the morning.
It is a goddamned shame in this country that people die when they can't afford to go to the doctor or pay for their medicine. It should be criminal.
I'm lighting a candle for him tonight and for my husband who has lost his entire family in the last two years but as a healthcare professional, I realize it is pretty much just going through the motions now.
It shouldn't end like this...for anyone. He's just one of many that are thrown on the pile of uninsured dead people in this country.
But hey, put on a bracelet for Tony Snow. At least he has healthcare coverage that we all pay for.

[Nicole]

1. I'm sorry to hear that.

You're right, no one should have to go through that. It is definitely criminal that those in need of health care don't have access to it. Or the ability to pay for it if they do get access.

Good thoughts for your family.

[leftofthedial]

2. gotta love capitalism

dontcha?

[Oeditpus Rex]

3. Similar thing happened to my best friend awhile back

His BP spiked and he lost a kidney because of it. But it was actually kind of serendipitous because while removing the kidney, they discovered a very small cancer growth — early enough to stop it.

He's doing well now. All it really cost him was a kidney and about 50 pounds.

I wish similar success for your BIL.

And, yes — it is criminal.

[area51]

4. k&r

It's criminal that our tax dollars are thrown away on boondoggles like the Iraq/Afghani war, yet politicians say we "can't afford" single-payer, universal healthcare like the civilized countries have. It's insane to tie access to healthcare to one's job, and republican insurance companies practice medicine w/o a license by denying people healthcare. :grr: I have a good friend who was injured from having undiagnosed diabetes, as he couldn't afford a doctor's care. He's had to apply for govt. disability and medicaid due to his injuries. We need single-payer healthcare now.

[OmmmSweetOmmm]

5. Hugs to you Horse and sending out healing thoughts for your brother-in-law.

I am uninsured too.........

[undeterred]

6. generic blood pressure meds are cheap

and in this country, so is human life

[meldroc]

7. Another casualty of the class wars.

The ruling class needs more Learjets and 150 ft yachts, so we must all make sacrifices...

[WiseButAngrySara]

8. It should be criminal. So sorry you are going through this.

I will light a candle too.

[Horse with no Name]

9. Update.

None of this really makes sense, but it seems like someone screwed up.
When he arrested, he was feeling like he had to urinate. The nurse apparently pulled the catheter out "in case it was kinked"?? and then tried to put it back in. Apparently when she did this, she met resistance but forced it anyway(which is a HUGE no-no). That is when he started massively bleeding and his heart brady'd down and stopped.
They claim that they only gave 3 amps of epi, but in this situation, atropine CAN be given...and one of the side effects is pinpoint pupils. They claim they didn't give it, however, I am not convinced.
This morning, his pupils are showing some signs of reaction. He has quit posturing, but the doctor wants the family there for a "meeting". My BIL's friends are there and his nephew, but I told my husband to assert to the nurses and doctors that HE is the only remaining legal next of kin and NOBODY is allowed to make treatment decisions except him.
It galls me that with the HIPAA laws, that friends are even being asked to make the difficult decisions on DNR's.:mad:
I am a realist and feel that pulling the plug at this time isn't an option. I'm also not going to advocate him languishing around on life support for weeks on end but it pisses me off less than 15 hours after the fact that they want to have the "family conference".
My husband will be flying out this afternoon. It is always amazing but never surprising that it always comes down to the bottom line.

[uppityperson]

18. vasovagal stimulation from full bladder + forceful reinsertion?

This whole thing is unacceptable.

[Horse with no Name]

19. That's my take on it

They called it a cardiac arrest but it seemed like a vagal thing to me as well.
He was back in less than 5 min--total code episode was less than 14 min and it was strictly atrial>>flutter, fib then asystole--no lethal ventricular rhythms so he didn't require defibrillation.
He was talking and lucid when she started jacking with the catheter.
I will stipulate that this was a man on the edge of a high cliff with his medical problems.
However--I think she pushed him off.
I asked last night if they thought he had a stroke because of the neuro symptoms they were describing, but they assured me no.
However, in light of his multi-system organ failure they did a CT of his brain this afternoon. Another result we are waiting on.
BUT--this morning, I asked if they had inserted the SP Tube and they told me that they were waiting for his bladder to feel distended.
Have they never heard of a bladder scan? We do these at the bedside in 4 minutes.
But I also told them that he was complaining of discomfort WHEN he went down, so considering they never got the catheter back in--what makes them think that part changed?
I sent my husband with instructions to request dialysis. I have seen situations where someone is dialyzed a couple of times and removed the toxins and that it can basically kick-start the other organs.
The nurse this morning said that he was on vent-assist and breathing over the vent 40% of the time, the nurse this afternoon said that he was breathing over the vent 60% of the time, the nurse tonight said that he had been on mechanical ventilation without assist all day.
You can be assured of one thing--if we pull the plug it will ONLY be when I am convinced and I am not yet.
Thanks for your concern. It helps to talk about it.:hug:

[uppityperson]

20. Hang in there, it really really sucks to be on the patient/family side.

I walked in the room when my mother was dying, turned and walked out thinking "I can't do this, I want to be on the nurse side". Went back and did it with the rest of the family, but it is really difficult. It is good that you know what you do, can advocate for what you can. Hang in there and give them hell. He needs much more than 24 hours, hell, look at Schiavo. (hmmm, call Frist? Never mind, sorry, bad joke). They need to do what can be done, need to know that they are not supposed to just shrug and say oh well. Yes, dialysis could be an option, get the toxins out and give the body a chance to get back on track. Is moving him to a place that has their act together an option? Keep an eye on them and it is really too bad you have to go through this and good that you are experienced on the nurse side.

Don't let them give up on him because he is uninsured. That is a totally bogus reason and there are ways they will get paid. Hang in there and please let us know what's up.

[Warpy]

23. Unlikely

Have you ever seen a urologist put one in with an obdurator? Not a pretty sight and much more forceful than a nurse using her own two hands.

I think we're talking about coincidence here, not causation.

What is unacceptable is having someone die ahead of time because there was no way for him to get cheap generic drugs that would have preserved his organ function for the foreseeable future even when he had no income.

Single payer NOW. Expand Medicare NOW. No more incremental bullshit! Don't accept anything less!

[Horse with no Name]

25. Yes.

But from what the friend said (and it is second hand)...that he had an obstruction.
The nurse kept pushing--and blood started spewing everywhere. From what the friend said, it was on the floor, in the sink, etc.
I also understand that my definition of "a lot of blood" and a layperson definition of "a lot of blood" is very likely to differ.
BUT it was undisputed that he went down immediately after the bleeding started.
Who is to say?:shrug:

[tandot]

10. I am sending you positive thoughts

I hope he will recover fully.

This is one f*cked up system we have here. I am lucky because I have good insurance. So many people are not as fortunate. We need health care fol ALL.

[truedelphi]

11. Reading this OP, I am just too angry to say much

But please don't take my lack of words to mean that I am not on your side.

Prayers for your BIL and the family and friends.

[philly_bob]

12. "Thrown on the pile of uninsured dead people" in America... HOWL! /nt

[Joe Fields]

13. I'm so very sorry. Sounds like the scary and unsure road I'm on.

[brer cat]

14. I'm so sorry.

My sister is a RN and stays on my back constantly about my meds, but I'm also uninsured and can't afford them all.

I hate to ask this, but do you think they asked about DNR because he didn't have insurance and they were trying to minimize costs? My only experience with DNR was with my elderly, terminally ill parents, and we were not asked, we brought the subject up.

I will keep your family in my thoughts and prayers. What an awful time for you!

[Horse with no Name]

15. Take your meds

Even if you have to go to Walmart and buy the $4 prescriptions--take them. My BIL is only 48. He is one of the kindest men you would ever meet.
It isn't looking good although we have been getting conflicting reports from nurses and the other folks there. We've heard from two of his friends today that he communicated with them AND that the doctor was in the room when this happened and acknowledged this--yet the nurse said his neurological status has deteriorated from last night--even though they said last night his pupils were fixed and pinpoint but they are reactive today.
I requested a urologist see him because of the botched catheter episode...yet I have yet to be informed if they have done that.
I just got back from taking my husband to the airport and am waiting on him to check in and let me know the entire situation.
I am an RN also and I absolutely think the DNR was requested because he is uninsured. Nothing will change my mind about that. We aren't unreasonable with unrealistic expectations, but feel that 48-72 hours will give us a very good grasp of the situation and allow us to make an informed decision and we will NOT budge on that time frame--and we don't give two shits if the hospital likes it or not.
My husband is his ONLY living next-of-kin. He has called the hospital and told them so, yet they are asking my BIL's FRIENDS if they want to make him a DNR?
That is bullshit. Luckily, the friends have called us and we have unequivocally thanked them for being there until we could get there, but also firmly stated that this isn't their decision to make.
Thank you for your prayers. Please find a way to take your medication.:hug:

[uppityperson]

17. My best wishes to them and an idea for you.

Threaten the hospital with liability stuff regarding next of kin, HPPA stuff. You know the routine, "based on liability issues, you sure as hell better do this right" sort of thing. Also works as far as urologist and other care. "Do you really want the liability risk you are running by NOT getting him the care he needs and by NOT going through the proper channels for DNR requests?"

48 yrs old? Give him a week before DNRing him. Sounds like perhaps he needs to be at a better place or give them hell. Money talks, threaten them with liability issues. Doesn't mean you will do anything (or may) but just mentioning it, several times, can help.

This is bullshit. Hang in there, keep advocating and best of luck to your BIL and MrHorse.

[Horse with no Name]

21. Well I have to tell you the bad news

He also lives in Texas. With tort reform, since my BIL was unemployed, according to the state of Texas, his life isn't worth anything and he is unable to sue nor are we able to sue on his behalf regardless of any malpractice.
Without funding, we can't move him anywhere....but even if he had it, he isn't stable enough to move.
We contacted the hospital social worker yesterday, because you know as well as I do that they will be motivated to help get him on Medicaid so that their bill will be paid.
Apparently one of the nurses told one of the friends today that we shouldn't worry about the funding part of it--however, I told Mr. Horse that he needs to do everything like he is bringing his brother home so in the event things do improve, we won't get caught with our pants down and nobody willing to help him get Medicaid.

[uppityperson]

22. WHAT??!?!?!??!? Oh that is crap.

I figured he isn't stable enough to move, was just thinking about it. But tort reform, unemployed, no malpractice? What the hell? Yes, there are ways to pay, Medicaid does catastrophic things, I figured I'd have to do that if I ever got seriously sick when didn't have insurance. Yes, start working on the Medicaid stuff, better they get paid some than none. But no malpractice available? That is just, sputter, sputter, sputter.

I hate threatening, but would point out their being very sure, due to liability stuff. No malpractice? At all? Oh give me a break TX. I guess they must be saying that any malpractice is based on what he makes, which at the moment is nothing? sputter again.

[Horse with no Name]

24. Yes.

You can only sue for what they determine your financial worth is--and if you are unemployed, no matter how egregious the errors, your life has no worth.
Yeah. It sucks.
Did a legal nursing case a couple years ago with a botched surgery and a nurse that didn't recognize the s/s of pulmonary edema.
The lady died and there wasn't an attorney that didn't agree that it was malpractice...but since she was unemployed, it wasn't profitable for them to sue.:mad:

[brer cat]

27. That's outrageous!

His life isn't "worth" anything??

How fortunate that you are there for him.

Please keep us posted. :hug:

[Warpy]

26. You are wise to wait

I have seen people come back from this, although it's unlikely given the general state he was in when they brought him in. There is still some room for hope, though, and your time frame is certainly reasonable for a lightening of his mental status.

You do have my deepest sympathy. The hardest thing I ever had to do for my parents was let them go when the time came. I hope it won't come to that for you.

[AtomicKitten]

16. That's disgraceful and simply unacceptable.

I just got a notice that I was overcharged as an uninsured patient in a local Emergency Department by a whopping 30%.

There is something seriously wrong with a nation that doesn't bat an eye spending hundreds of billions of dollars on killing brown people and allows stories like yours to happen in America.

:pals:

[area51]

28. kick. (n/t)

[McCamy Taylor]

29. This is so sad for you and your brother. We need universal healthcare now.

[area51]

30. kick. (n/t)

[midnight]

31. It seems from your story/nightmare that crimes against the

poor go unchallenged. Who needs to make that much money. Remove the big vampires"insurance company's" and let the people have access to their doctors,meds, and healthcare.

[Blue_Tires]

32. ttt one time nt

[uppityperson]

33. Hi Horse, how is he doing?

[Horse with no Name]

34. Hey there

He is about the same. He had periods of opening his eyes yesterday in response to verbal stimuli, but so far today, none.
He is doing some involuntary stuff like yawning and twitching--I had to burst everyone's balloon that that really didn't mean anything.:(
I just got off the telephone with the diocese priest and asked them to go administer his last rites/sacrament of the sick.
Apparently Mr. Horse found his rosary on his bedside table so his faith was obviously on his mind and I would hate to deny anyone that.
The Priest said he would be at the hospital in about 30 minutes and was very accommodating.
Of course the suggestion made Mr. Horse upset(because of the suggestion that he wasn't going to pull through), but this isn't about any of us and what we want. It is about my BIL.
Also, just told him we call the Priest for any serious illness in patients if that is their wishes...and multi-system organ failure definitely qualifies.
Good news is the CT scan didn't show any stroke which we feared, but preliminary EEG reports are said to show minimal brain activity.
We are awaiting the attending neurologist to study those and give us an exact report.
Bad news is that he is ventilated and not needing any type of sedation.
They are considering doing a round of dialysis to see what happens there--but apparently the attending doctor has been very nice and when my BIL was conscious, told him that he would have worked with him financially if he had only come to him.:( and has repeated that several times to Mr. Horse.
Our timeline hasn't changed. Monday will be the day that we make the difficult decisions.
The hospital is doing everything at this point and we are pleased with that. He is getting the best of care and they are responding appropriately to our requests.
Thanks for yours and everyone's kind thoughts.

[uppityperson]

35. Thanks for the update, hoping things improve.

got the PM too, thanks for posting it here too.

[Horse with no Name]

36. Update

We've given it a full 6 days. There isn't any improvement. There isn't any meaningful response.
I have to say, that after Mr. Horse got there, the hospital did everything that they could. Everything.
Nothing was spared. We have had two EEG's...and he isn't considered "brain dead", but the wave patterns are very disorganized and indicate a very poor prognosis.
He had a seizure on Monday night and has run fever since then. That isn't a good sign.
We are going to take him on the ventilator tomorrow morning. There is always a chance that he will recover...but it will be without machines hooked to him to do it. We just want him comfortable and are moving him to the hospice unit.
It's all we can do at this point without compromising quality of life.
Thank you everyone for your thoughts and prayers.

[DearAbby]

37. I weep for you and others like you...

and for your husband. This must be so difficult for him. I am so sorry. I will continue to send healing thoughts and a :hug:

[TexasLady]

38. Damn, I can so relate with the horrors of high BP.

First, my thoughts are certainly with yalls family. I worry all the time that my own family may be faced with something like this concerning me. I have four kids and three are still home.My last three were born with me having really bad high bp. Not fun.

High BP, what a damned fiasco some of us go through. Ive had it since 30, so almost 14 years now. I finally got sick and tired of the massive headaches,double vision, feeling like my body was in a microwave, and broke down and spent a hundred bucks to get on permanent meds.80 bucks per visit to continue the meds..so if the meds werent working, thats yet another 80 bucks for what? to get my bp taken, and a small switch to my amount of meds. This will go on for the rest of my life.

Worst thing that happened was going into atrial fibrillation, 155 beats per minute, in the ER, and scared to death, literally.
That cost about 4 grand...and I have no idea how that is supposed to get paid.

My doc and I found something that works,and is cheap. The bad part is there is no way I can do much moving around without my pulse going sky high. So I dont do much.

I feel soo sorry about your BIL, because I cross my fingers all the time that my meds, that make me feel like crap, are at least keeping me alive.

The system is a joke. I know, cause I have to rob out of the bill/food money just to stay safe from the very complications your BIL is going thru.

BIG hugs to your family. Candles are going to be lit here as well.

[JanMichael]

39. I'm sorry to hear that.

We should all have access to quality healthcare but sadly there are too many greedy people in this country to get that to happen.

I agree that this should never happen.

Take care.