Emergency Room Wait and the "ASSESSMENT"

http://www.usatoday.com/news/health/2008-10-21-hospital-fee_N.htm#uslPageReturn is an October 23 article in USA Today that explains how a woman who waited 19 hours in a Texas hospital waiting room and never received treatment received a $162.00 bill for the "assessment" performed by hospital personnel to determine the priority of her case (broken leg). The same hospital had allowed a 58 year old man to die within their walls of greediness as he waited a similar nineteen hours. The article focused on the "assessment" fee and how some hospitals do charge for such fee regardless of whether service is rendered and some don't...sort of like companies that make you pay for an estimate whether you use them or not and those that don't.

Here we address the nineteen hour wait, for the woman with the broken leg who never received care, she survived, for the man who never received care, he did not. First, the lawsuits against this hospital should be flying, negligence, gross negligence, incompetence claims against those who made the "assessments", and more likely than not some phony record entry to cover their butts. But regarding the assessment, most people who have been in an emergency room become increasingly aware that seeing the assessor, the person who takes your vital signs often is used as the STOP THE CLOCK moment. This woman was assessed three and a half hours after entry into the emergency room. After nineteen she was never seen. The hospital records will show that she was "seen" in three and a half hours and since she didn't sign out, it will never reflect that she left after nineteen hours of waiting. That's why the death of that 58 year old patient should not be in vain...without serious records tampering, the hospital can't change that he died while waiting for care.

That man's records will also show that he was "seen" and "assessed". That's how hospitals avoid any sanctions that might be imposed for their gross negligence, incompetence, failure to provide a reasonable level of care, in emergency rooms.
But if that man never left the emergency room then his time of death will present a silent indictment of this hospital.

It is greed that promotes ER waiting times. Most ER's have average flows of patients, barring catastrophic emergencies that involve a spike in the number of patients. This means that ER's can PREDICT how long it will be before a patient is seen. But hospitals don't do this, and they certainly don't refer patients to alternate sites for treatment, that would be lost revenue. Like airlines that overbook, or the pediatrician who schedules twenty 1:15 appointments, less than full capacity is less than full money making. "Someone will be with you shortly," "busier than usual", are all double talk that keep patients in limbo waiting for treatment.

Stopping the clock Hospital records will show that this woman was "assessed" after three hours or so. They will not reflect that she left the emergency room untreated after nineteen hours and therefore, it's her word against theirs. The "assessment" itself will have to be challenged, who it was performed by, whether it was sufficient, and perhaps this "assessor" was the same one who in her ER wisdom determined that the dead 58 year old was where he needed to be in terms of treatment as well.

RE-Assessment It is arguable that a reassessment is warranted in the case of patients who spend additional hours waiting for actual care after their "assessment". This also will not be arguable for this woman because she didn't sign out. However, in case of the dead patient, the "assessment" process itself can be challenged. After x hours additional assessments are warranted to determine whether a patient's vitals have changed or whether a patient is going into crisis.

What you can do: Keep track of the time. PROVE how long you are in an ER by requesting that "assessor" sign and time a handwritten note if you leave the ER. If personnel don't or won't cooperate, ask other patients to sign, date, and leave their phone numbers verifying time. Then go to government agencies and government representatives. Government representatives who enjoy superior medical insurance off our dollars must be notified...they are not paying the same amounts "regular" people are paying. Send your information to local news reporters.

Get your "assessor's" name: Make sure you have the name of the person performing your assessment and his/her credentials. This will also prove your time in the waiting area. If the assessor changes, get the new name, most people don't put in nineteen hour shifts.

Regarding the "assessment" fee, notify your consumer affairs department and ask whether such information must be clearly posted. If not, ask the hospitals in your area about their assessment fees.

In times of emergency, it's difficult to think of any of this. And for those in the emergency room alone, this may not be feasible. However, many people are not alone in the emergency room. Communicate with the person who accompanies you.