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Trisha Torrey

Follow the Money to Solve the Mystery in These Hospital Records

By October 7, 2012

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While visiting Sarasota, Florida, I found, in the morning newspaper on the front page of section B, a headline: Hospital records, or works of fiction?

The answer is so very simple: they are the records, and they are fiction, and to find the explanation, you just have to follow the money.

Let me explain:

Last month, a homeless woman named Devon McGann, arrived drunk in the ER. There wasn't really anything medically wrong with her, so they let her sleep it off, then sent her out the door, despite the fact that she was still "addled" (that's the newspaper's term, not mine) because she had been taking drugs, too. Two hours later, Devon walked into the path of an oncoming car and was killed.

In Florida (and I suspect every other state and province, too), and, according to the hospital's own policies, for safety purposes, any patient who has been admitted to the ER for mental health or substance abuse reasons can only be discharged to the care of someone (friend, family or professional) who will accompany them out the door. The police, wondering how it was that Devon was wandering the streets shortly after her discharge, got copies of her hospital records. They stated that Devon had been discharged to her boyfriend's care.

Only one problem. Her boyfriend was in jail.

So the question asked by columnist Tom Lyons in this morning's newspaper is whether or not the hospital might be fudging records. He further cites reports from a number of other recent patients who testify that they or a family member were also discharged on their own, with no one to assist them.

It floors me that there is any question about whether those hospital records are fudged. It happens every day. And it happens for the same reason everything else happens in healthcare: follow the money.

This was a homeless woman. She had no insurance. Any reimbursement the hospital might have gotten from whatever source (if any) could not have covered the cost of her care. I suggest that may also true of every other patient who reported being discharged to invisible parties. Either they had no insurance, or they had inadequate insurance.

It happens every day - and it's easy to see why. Further, it saves us all money. When people enter the ER without insurance, or with inadequate insurance, there is little chance they will ever be able to afford to pay the bill. When they can't afford it, then WE - you and I - foot that bill.

But we pay for it over time as the hospital fudges its other billing and reimbursements. The problem is, the hospital has to pay to run its services immediately - through paychecks or supplies - so if they can get rid of the patients who can't pay them, or who will take awhile to make up the difference - then that's what they will do. That's how they release patients to invisible family members and friends. But of course, it's all under the table. They can't let the records reflect that.

You may remember several years ago when a woman in California was just dumped on the street by hospital personnel. She was homeless, too, and had a chronic lung condition. Over the next many months, it was learned that hundreds of patients had been dumped in just the same way.

Sending people out the door on their own is no different from dumping them elsewhere - except that there is no cab fare involved. (More savings!)

This incident, and all the others, raises questions for us, though. Some ethical, and some that are more about our own financial stability....

If you ran a business, and your customers wanted you to work for them, but you knew they didn't have any money, would you want to keep working for them - at the expense of others who need your services and can pay you? Don't forget - if you spend too much time as (what is, in effect) a volunteer - your business will go bankrupt, or at least you won't be in business very long.

If you are a customer of a business, and you observe the employees focusing on the people who are being served for free, and you can't get the help you need - what do you think of that business? Will you be their customer again? No - you will probably go up the street to another business so they can keep doing their volunteer work.

Further - how willing are you to pay to keep a drunk or stoned patient under hospital care? Is that how you want your money spent? Because when someone who is under the influence is admitted to the hospital, with no health insurance, that is what happens.

In this case, the hospital is probably trying to protect itself, for better or worse. And they are trying to protect their other - paying - customers, too. They are trying to balance the needs of everyone so they can serve everyone.....

Or are they?

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Agree? Disagree?
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Photo 123rf / Bidouze Stphane

Comments
October 11, 2012 at 5:40 pm
(1) Nancy 255 says:

Hospitals aren’t the only ones who write fiction in medical records. I’ve had doctors do it too–until I started requesting copies of all my records. It’s amazing how accurate and objective they can be when they know we’re watching!

February 2, 2013 at 12:29 am
(2) gemdiamondintherough says:

Yes, It is called taking charge of your own health care. Just “recently” when referred to a specialist, I was privy to a copy of the letter sent to my PCP. Since my PCP now has a system in place where you can communicate through email, I asked this specific question. How do we correct something in my chart that is not correct?? The answer was that I guess it depended on what it was. But that they could record my version in the record, if I so requested. That would not remove what had been charted, but at least it would hopefully make them think twice about what JUDGMENTS they chart next time, rather than just stating the facts!!!!!!!
Too many times care providers are charting judgments, rather than pure and simple facts. I do realize why this may happen. That was one of the first things I was taught!!!!!!!! But either because we get busy or sloppy, care givers remember it is not what you think about the patient and their choices that you chart. IT SHOULD JUST BE THE PURE, SIMPLE FACTS!!!

October 26, 2013 at 4:52 pm
(3) Gloria says:

Years ago a friend of mine saw a specialist who had diagnosed her older brother with an “incurable” illness. After tests were done the specialist told my friend that (in his opinion) — she did not have the same illness. When she spoke with her family doctor (with whom she had a great relationship), she was told that the specialist had sent a letter saying that he believed that my friend also had the same illness as her brother.
So I wonder WHAT was recorded in the specialist’s records and what was the family doctor to record in HER records??

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