Our US Health care System

[mtshastawriter]

My husband is currently in the CCU in a hospital 90 miles from home. There are no dialysis centers here, so for him to get treatment while admitted, he has to go down to a larger area. This is not our first rodeo, but it's a great example of the dysfunction in our health care system in the US.

This hospitalization is for an MRSA infection in his blood as well as pneumonia.

Tuesday night we called 911 because he was face down on the floor and too weak to stand up. He had been to the doctor the day before, and the dialysis clinic that day, and both thought he looked sick but not "too sick."

So, they take him to the local hospital by ambulance who diagnosed him with the pneumonia. They transfer him down to the bigger hospital by ambulance. He spends the entire day there in their ER and then they decide he is "fine" and can come home. So, I go get him and he is clearly not "fine" but we make it home and in the house. (And, the hospital sent him out with his IV still in his arm....)

Next morning he is complaining of excruciating pain in his hips and shoulders. At about the same time as we got him out of bed, the local hospital calls to say he has tested positive for an MRSA infection in his blood and now needs emergency IV antibiotics and to call 911 and have them bring him back.

The ambulance shows up and can't believe he is still home, as they were the crew who took him down to the larger hospital the previous night... Actually their exact words were "what the hell is he doing back home this sick?"

The local ER

[mtshastawriter]

Oops. clicked the wrong button.....

Anyway, the local ER, on the second day, tried to drug him with pain medication and send him home again. I went to get him and he was totally out of it and couldn't even sit up in the bed.

Finally, after I asked why he was not being transferred down to where the kidney doctors can treat him, they tell me that they hadn't thought of that. Duh, he is on dialysis!...

They called the nephrologist who admitted him to the hospital. Where he is now.

So, for a needed hospitalization, there will be 4 ambulance trips, 2 of which were over 100 miles each. We have had our volunteer fire fighters here twice. It's just been a total nightmare...

[kansasflower]

Shasta, so sorry you and your husband are going through this difficulty. Hope your husband gets better soon.

[stats45]

This is just insane. I hope your husband gets well soon and that you are doing well.

It seems like an argument for electronic medical records that everyone is able to access quickly at the very least. I'm always shocked by how much doctors' overlook in medical histories due to errors, missing records, etc.

[mtshastawriter]

Thanks for the good thoughts. I am not a believer, but DH always appreciates prayers.

The last time it took 4 trips to a local ER before they could get approval to transfer - followed by SIX WEEKS in the hospital. I still think that if they had admitted him sooner, then he wouldn't have been in there so long and be so weak when they sent him home...

It was almost laughable when they told me, after the last ambulance trip to the local ER, "well, we just can't check off all the boxes to get Medicare to admit him." Okay.... Seems the nephrologist had a different box because he was transferred to the larger hospital and is in CCU. Every time I have tried to call or find out what's going on I am told he is either on a bi-pap breathing machine or having "tests."

[Bluerobin]

Cross the local hospital off your list and go to a competent one, even if it is further away. He just might survive that way and have fewer problems. Get to a better hospital without delay.

[phil5185]

It seems like an argument for electronic medical records that everyone is able to access quickly at the very least. I'm always shocked by how much doctors' overlook in medical histories due to errors, missing records, etc.

I'm always amazed at the racks & racks of Manila folders full of paper. All faxed back & forth between docs, specialists, hospitals. The profession seems to be about 15 yrs behind Industry on this one, the excuse is always 'privacy'. Geez, fix the privacy issue and move forward.

[swamp]

Blue, sometimes you can't just go to a different hospital when you live in a rural area. The volunteer rescue squads will transport you to the closest hospital, and sometimes the next closest is 30 miles away. So unless you can afford to call a private ambulance service to come get you, that's assuming there even is one, you're going to where they take you.

[mtshastawriter]

The local ambulance service will only go to a local hospital. The 2 local hospitals do not support dialysis patients. So, the only way to physically get him to a larger hospital is to have him transferred there. The problem with that, as we have discovered, is that the hospital can refuse to admit him - even after the 100 mile ambulance drive down there.

I just talked to the hospital and they had to give my DH blood last night and he is still septic with pneumonia. Apparently on Monday they are going to do some nuclear medical test to put a tracer on his white cells to see if he has a localized infection in some area they can't find... He is still mentally "off" and when I asked if he was coming home on Monday, they said "absolutely not, he is very ill." At least they finally figured that out!

[swamp]

Shasta, maybe I misunderstood you, but are you saying the smaller hospital will arrange for a transport to the larger hospital, but then the larger hospital still won't admit? That's nuts!!

I live in a rural area, and all the small local hospitals have working relationships with the 2 large medical center university hospitals within a 3 hour drive. They're linked electronically so the docs in the big city can see the test results at the local hospitals and the docs determine together if a transport is gonna happen. If it's gonna happen, the large hospital is on notice the patient is coming.

I live in BFE, so if it can be done here, I don't see why you can't get on the case of your hospital board to get their act together.

[DVM gone riding]

the problem isn't really the us medical system but the medicare system, hosp get more money by admitting you multiple times rather then just once, and either way most medicare patients cost them money.

[❤ mollymouser ❤]

Shasta ~ I am sorry you and your husband are dealing with this and will be thinking about you both (and this situation) as well. I'm in central California ~ is your DH in one of our local hospitals or do you live elsewhere in the state?

[DVM gone riding]

I would argue there is nothing "basic" about his care or the local hospital would treat him, his care is highly advanced requiring specialization. And that is the difficult and the problem we are facing as a nation we have to decide how much advanced care we will pay for otherwise dying people. Don't think I am heartless, I feel for the OP the terrible situation she is in and her sick DH but it is costing us taxpayers an arm and a leg to support him in what is end of life care-people that go on dialysis only come off one of two ways and he is to sick for a transplant.

[formerexpat]

The profession seems to be about 15 yrs behind Industry on this one, the excuse is always 'privacy'. Geez, fix the privacy issue and move forward.

Easier said than done with HIPAA - thanks Ted.[/size]

[mtshastawriter]

I agree with DVM in that DH's care is very specialized and is costing the taxpayers millions upon millions of dollars. (Dialysis treatment and EPO injections together bill Medicare over $800K per year!) Add to that multiple admissions to the ICU and surgeries each year to keep his dialysis access working, and he easily costs a couple million dollars per year.

DH has been disabled since 1998 and has been on hemodialysis now for about 5 years. For the last three we have done his treatments at home because the 90 mile drive is just too far. Doing them at home requires about 5 hours a day, 6 days a week. He's like a full-time job to take care of....

The problem here is that an ambulance will only take him to a local hospital, even though there are no dialysis services in our county. They then have to agree that he needs admission and transfer him down to a larger city. (Redding, Molly, we live in the Yreka area of CA) The first time they did this, last week, they held him in their ER and then sent him home. We barely got him home....

The next day they called to say he has MRSA in his bloodstream and had to go back to the hospital immediately for an IV. Once again, since he couldn't walk to the car, we had to call the ambulance who can only take him locally.... Back to the ER who tried to send him home yet again.

I finally did some serious yelling and made them call the nephrologist again and got him admitted to the larger hospital. So, they took him back down there by ambulance again.

DH is currently in the CCU with an MRSA infection in his blood. He is septic and his condition has continued to decline despite the strong antibiotics. He is having a nuclear medicine scan today to trace his white blood cells to see if he has another infection other than in his blood and lungs.

I tend to read, when stressed out, and have seen that the longer you wait for treatment when septic the worse the outcome. If he dies, because they refused to admit him earlier, I swear I should be able to sue. I won't, but it just seems that they made his illness possibly worse by not taking action when they had the chance the first time! Pisses me off....

Anyway, DH would appreciate prayers for a recovery. As would our two teenagers.

On the money front, if something happens to my DH I will immediately loose almost 100% of our family income. I have a couple thousand dollars which should last a couple months, but it's going to be really bad. So, I am stuck in this waiting place - should I find a job, find more freelance work, hang in there....? It's stressful.............

[workpublic]

any way you could move closer to the big hospital?

[Urban Chicago]

For the last three we have done his treatments at home because the 90 mile drive is just too far.

I know you probably love living in the country, but with this and the ambulance issue, I would be moving to the larger town. Even if that means selling at a loss, a school change for the kids, etc...

Your DH's health is just too important to leave to chance, especially since you are financially dependent on him.

[Savoir Faire-Demogague in NJ]

I know you probably love living in the country, but with this and the ambulance issue, I would be moving to the larger town. Even if that means selling at a loss, a school change for the kids, etc...
Your DH's health is just too important to leave to chance, especially since you are financially dependent on him.

I'll second this. The issue is not the US Health Care system, the issue is access to nearby facilities equipped to deal with complicated health issues, such as the posters spouse.

[973beachbum]

mtshastawriter,

I know your husband has Medicare but is is straight Medicare or a Medicare advantage plan that is an HMO?

Either way I would call them up and see if they have any "health care coordinators" available that you can talk with. You really need someone there to coordinate you care for you! What is happening now is really more like a fire department coming to put out fires after the smoke is billowing like crazy. You really need someone to set up a plan to manage his actual health care so that all this nonsense doesn't happen in the first place.

Be a pest if they don't get you to an HCC keep calling and going up the food chain. All insurers have them, trust me.

[bean29]

I find it hard to beleive as common as diabetes is that you don't have a dialysis center closer to you. I beleive you, I am just flored that the medical facilities in your area don't provide this service.

Dialysis places seem to be all over the place by me. One wonders if there is enough business to support the clinics. Thought this was to be a growth area for Medicine in the next 10 years or so.

I know sometimes you do have to argue with the hospital staff. If they can discharge you, your problems are no longer theirs. We have had similar issues with my Dad. He has had C-Diff several times in the last two years. He can not walk either. My brother talked the hospital out of releasing my Dad once when he was in a manic high and could not walk. My Mom is learning too that it falls on her to check with all the different specilists and make sure that all the bases have been covered.

How they can take a obviously very sick patient and relase them b/c they can not find a medical explanation is beyond me.

My thoughts and prayers are with you and your family.

[bean29]

On what you should do about future employment, I guess you need to think about possible careers you could do and then think about where the need is. Can you do this in the community you currently live in?

Where can you attain the education you need? Can you do it on-line or do you have to attend a university far from your home?

Also I know your sons are young adults finishing up high school and ready to make college decisions themselves. You probably want to make their transition to college as seamless as possible.

I have a sister finishing up her BS at 48 and an Aunt who finished up her teaching certification at about 50. People do go back to school at your age, but it is not easy.

But from your posts in the past we certainly know that your life has never been easy. I am sure you can handle college at this stage in your life.