Healthcare: A Tale of Two ERs

On Wednesday of the Democratic National Convention, I spent over six hours in an emergency room and two urgent care facilities, trying to get treated for a bronchial infection that I feared had turned to pneumonia.  The story of the treatment I got (and didn't get) in two different urgent care facilities on the same day illustrates why healthcare in this country needs serious, thoughtful reform.  John McCain may claim that everyone has coverage by going to an emergency room, but I wonder when was the last time he visited a public hospital ER to see what goes on there.

I started getting sick the week before the DNC.  My family had taken a few weeks of vacation prior to the Convention to travel the Western States and some of our glorious national parks.  While at Yellowstone, I developed a nasty cough that kept me up through the night.  I went to the Medical Clinic at the park and saw a doctor who diagnosed me with "allergies, asthma, and altitude," gave me an albuterol inhaler, and sent me on my way.  A 10 minute visit cost $247, which may or may not be covered by my insurance.  He did not do a chest x-ray or anything more than listen to my breathing with a stethoscope and take a short history.

I got to Denver, and since I had no other symptoms other than being tired and the hacking cough, I tried to do all the activities I was supposed to do to cover the DNC.  We were working from 8 am to 1 am most days.  I took a turn for the worse on Tuesday night, with uncontrollable coughing, headache, joint pain, and chest pain.  I slept maybe two hours that night, and got up with no voice, a raging sore throat, earache, and could not stop coughing.  After consulting WebMD aka The Hypochondriac's Bible, I started to worry that I had developed pneumonia. I decided to seek medical care again.

I called my insurance company and asked for a referral to an urgent care clinic.  They gave me three names and numbers in Denver.  MOMocrat Donna was helping me and asked the hotel staff for a recommendation.  They first suggested an urgent care clinic downtown, then said that the Denver Health Center right across the street, was over-staffed for the convention, so we should try there.  They thought I could be seen quickly.

Since it was across the street, we walked over and signed in at 12:30.  I could see the names of all the people who signed in before me, which seemed to me to be a violation of the patient privacy regulations in HIPAA. We had a meeting downtown with the editor of More Magazine at 2:30, and I hoped I could get in, get some kind of cough syrup that might work, and get to our meeting.

At 1:00, I was seen by a friendly nurse, who took my blood pressure, checked my breathing, pulse oxygen, and took a thorough history.  I was sitting next to another patient who came in for medication for chlamydia.  I know this, because we were in the same small room together and could hear every answer to every question, and she could hear mine.  I could overlook the sign-in sheet, but this was ridiculous as patient privacy violations go.  I learned more about this woman's sexual history than I know about my own.  I learned how many times she had various STDs and when her last period was.  I'm pretty sure the people in the waiting room heard it, too, if not everyone in the Denver metro area.  She was loud and appeared to be drunk.  The nurses were very patient with her, but it seemed like they knew her. 

The nurse determined that since I was not having a heart attack, suffering from a gunshot wound, that I was not "emergent" enough for their service and sent me around to the Adult Urgent Care Clinic.

"Urgent Care" is a misnomer, since this place was not "urgent" nor did they care.  We walked into a room full of about 40 poor people, most of them coughing, sneezing, crying, wheezing, or just slumped over in their chairs and wheel chairs.  Most of them were Spanish-speaking or elderly.  Some of the women had infants in strollers with them. They were there because they were sick and had no place else to go and no childcare to keep the baby safe from the germs in that room. 

It was like being in a 19th century tuberculosis ward, as described by Charles Dickens.  The room was under construction, there weren't enough chairs for all the people, there was no water or food available, and very little ventilation.  If there was air-conditioning, I sure didn't feel it.  "Days of Our Lives" was playing loudly on the TV in the corner, but no one was paying attention to the fully made-up Marlena Evans in her glam hospital bed.  We were too busy being sick and ignored.

I signed in again, once again, noting that none of the names ahead of mine were hidden, and waited to be called. 

At about 1:30, they called me up to take my insurance information, and reason why I was there.  This was in full view and earshot of everyone else there. They made a copy of my insurance card and driver's license, and gave me a paper bracelet to wear.  They told me I probably would not have to wait long.  I held out hope that we would make the meeting at 2:30.

At 3:00, after I had been there for an hour and a half, coughing and wheezing, a nurse appeared from nowhere, and slapped a mask in my hands and scolded me, "You need to wear this."  I couldn't get it to fit right, so she snapped my face with it and pinched my nose.  I seriously wanted to punch her.

The mask made the warm, stifling room even hotter.  I coughed into it, and since I was already short of breath, could hardly breathe through it.  I thought about leaving.

Donna sat patiently beside me, and I twittered what was going on from my cell phone.  One twitter buddy suggested that I go up and tell them that I was liveblogging the entire episode, to see if they would get me in any sooner.  I thought about playing the attorney card, but figured they already knew that since they had asked my occupation and I said, "Attorney/Writer." If it had not been for Donna and Twitter, I would have lost my mind.

At 4:15, a woman came out of the examining room, hysterical.  She said to the front desk that she had been there for 5 hours and had not been seen by a doctor yet.  She demanded to know when she would be seen.  A nurse came out and said that all the attendings were busy and she would be seen soon.  She shouted, "I missed a whole day of work for this?  I am sick!  Where is the doctor?" 

That was it for me.  I realized then that for 3 hours, people had been called, and not a single one of them had come back out.  I feared that I would go in and leave Donna in the waiting room for 3 more hours.  I told Donna, "I can't take it any more."

I walked up to the desk and whipped off my mask and bracelet.  I told them to remove my name from the list, and that they had better not charge me for waiting 3 hours.  In my hoarse, low, nearly-gone voice, I told them it was appalling that all of these people had to wait so long.  The young male desk attendant just shrugged.

On our way out, a frail African American woman in a wheelchair was sobbing and wheezing into the payphone in the lobby.  She said she had been there for hours, couldn't breathe, and no one would help her.  At this point, I started to cry.  I got back to my room in the hotel, and really sobbed, not for me, but for all of them.

I cried because I knew I could walk out of there an into a private clinic, but the others there likely had nowhere else to go, or no insurance to use if they got there.  I cried because none of them had a choice but to sit and wait.  I would guess that many of them have minimum wage jobs, with no sick time off.  Every hour that they sat and waited was missed wages.  Every hour they sat and waited was less food on the table, less gas to get to work, less of the basic necessities of every day life.  I cried for the infants in the waiting room, exposed to God only knows what, with sick moms who had no choice but to bring them there. 

I stopped crying due to another coughing jag, and called an urgent care clinic my insurance company recommended, Concentra Medical Center. They said if I got there by 5, I could be seen immediately.  They gave me detailed directions on how to get there, and I drove myself, coughing and crying all the way. 

I arrived at 4:50, to a clean, well-lit, empty waiting room. In contrast to the Denver Health Urgent Care facility, it was air-conditioned and had vending machines for candy, soda, and water.  I checked in, noticing that the sign-in sheet masked the names of everyone ahead of me, so my name was the only one that showed.  No HIPAA violation there.  I settled in to take some notes, figuring that I would be there a while.

They took my insurance information, called my insurance company, and told me the visit would be $35.00.  At about 5:00, a nurse called me in and took my vitals.  About five minutes after she was done, a very nice doctor came in and did a thorough exam, took a history, and talked to me about my experiences at Denver Health.  He spent at least a half hour with me, going over every possible symptom, even some I hadn't thought to bring up.  We were in a closed room, where no one else could hear him ask these questions.

He listed to my chest a few times, and didn't hear anything that sounded like pneumonia, but wanted to get a chest x-ray to be sure.  He left me to change into a paper gown, and got the x-ray technician.  I had 2 x-rays, they were developed, and I was sent home with 2 prescriptions within an hour of arriving.  He confirmed that I did not have pneumonia, but a nasty case of bronchitis, that was made worse by the altitude.  He drew me a map to the nearest pharmacy, gave me his card, and told me to check in if things didn't improve.

The difference between the hospital urgent care and the private urgent care was the difference between rich and poor in this country. I don't mean this to be an indictment of Denver Health; I know how over-taxed the public hospitals are, and that they are not the problem.  I do, however, think they need to take patient privacy a little more seriously or find themselves in a legal bind.

If you are uninsured in this country, you have no choice but to waste hours in an emergency room to be treated for anything from a chest cold to a sprained ankle.  If you are uninsured in this country, you don't have a $35 co-pay, you pay $247 or much more if you have any kind of test, right out of your pocket for a ten minute visit.  If you are uninsured in this country, you don't go to the doctor right away, you wait until your condition is so bad that it might threaten your life.  If you are uninsured in this country, you may not get paid medical leave, so all the time you spend in the waiting room is time away from your job, money out of your pocket, or time away from your children.  If you bring the kids along, you expose them to unknown health risks.

Regardless of whether we elect a Republican or Democrat to the White House, this has to stop.  I think it's going to take nothing short of a revolution to get healthcare out of the hands of corporations and the Republicans who gave it to them, and back into the hands of the people who need care, and the doctors and nurses sworn to "first, do no harm." 

All of you who are voting for John McCain, I hope your insurance premiums are up to date.  I hope you never get sick during the next 4 years.  I hope you don't have to file for bankruptcy due to breast cancer or heart surgery.  If you believed in Hillary's healthcare plan or John Edwards healthcare plan as I did, you won't get anything close to it in your lifetime if John McCain is elected and the Democrats don't get a filibuster-proof Senate.

John McCain, go sit in a large public hospital emergency room for a couple of hours and then say everyone is covered. 

I dare you.

Posted using the Sprint Compass™ 597 by Sierra Wireless, generously loaned to the MOMocrats for the trip by Sierra Wireless.

Comments

[Sharon]

This is the type of information - firsthand, factual, and easily checked - that needs to be broadcast from every rooftop from now to the election.

[Kirsten]

Your story resonates with me because like you, I've experienced both sides of the health car coin. My six year old daughter Meghan is epileptic. When she was less than a year old she suffered multiple seizures and spend a good portion of the beginning of her life in and out of All Children's Hospital.

There was a short period, during this time in our lives, where we had no health insurance and not for lack of wanting it. My husbands job didn't offer it and I had lost my job due to spending to much time at the hospital with my daughter (but that's another story).

We called multiple insurance companies to try and get private insurance but no one would insure my daughter due to her being epileptic and because we were above the pay bracket we didn't qualify for kid care or SSI. Apparently, insurance companies don't consider children to be epileptic till they're five and when they're under five there's a whole lot of double talking rhetoric, that doesn't make any sense, giving them reason not to insure her, bottom line they wouldn't insure her and we were willing to pay.

During this time Meghan had a status seizure that lasted two and half hours and she was airlifted to All Children's Hospital. The hospital we had gone to was ill equipt to take care of Meghan and thought oxygen attached to a paper cup was adequate treatment for child in status and it cost us dearly, because we we're unable to get insured.

We were very lucky to have a great pediatric neurologist who met Meggers at the hospital and pretty much stayed with her till we got there and called us on our two and a half hour trip to the hospital with updates. Due to not having insurance (that we were willing to pay for) we ended up with well over $20,000 in medical bills.

In my opinion, medical insurance shouldn't be a reward for good health so those companies can pad their pockets because they didn't have to provide. Medical Insurance should be something that is offered to everyone to ease the financial burdens that come from having medical conditions taht come up unexpectidly, be it epilepsy, cancer, or even a common cold.

[Donna]

This is a powerful indictment of what masquerades as a healthcare "system" in our country. I'd like to add the point that the $5,000 tax credit for private health insurance proposed by the Republicans is not going to do much to help people who cannot afford health insurance in the first place, nor those who cannot obtain health insurance because of a pre-existing condition - not without imposing REGULATIONS on the health insurance providers that would force them to cover people, keep their costs down, and live with a smaller profit margin. The free market is not up to ensuring that ALL American residents receive the medical treatment they need. It has to be a partnership with government.

[hall monitor]

Just found a story on http://detentionslip.org about 1,300 L.A. school employees getting their health care benefits cut. Hopefully Obama cleans up this mess.

[jaelithe]

I have had experiences like this in the ER even WITH insurance. Last time I had to go to the ER, with a severe infection, high fever, fever chills, and disorientation, I was taken in by ambulance and the paramedics asked that I be seen immediately. I was redirected to the waiting room for several hours, then put on a bed in a dirty hallway and left there for several more, right next to another bed in the hallway bearing a young boy with suspected bacterial meningitis. It was 11 hours before I even got into a room. I don't know when that poor child got into a room. Then I waited several hours more for tests because the hospital was awaiting my insurance company's approval.

The hospital never did definitively diagnose the source of my infection. They sent me home with some antibiotics after a day's stay.

Even people WITH insurance have horrible experiences like this.

The key difference is, with insurance, that lovely experience only cost me about $1500. Without insurance, it would have cost me about $10,000.

[Single, working mom]

This is something that will only change when everyone and I mean EVERYONE demands this be changed. There are a lot of reasons our healthcare is in such chaos. One of them is Illegals, I cannot say that they should be denied medical care in an emergency but the cost of covering them is breaking our system. The second reason is good ole American capitalism. The people who manage those healthcare monopolies are raking in the bucks while the rest of us are suffering, and some dying at the hands of some HMO ceo dictating who will receive what type of care. That should be up to the doctors and only the doctors, The third reason is as always Our government officials and special interest. If I remember correctly there have been many bills sent to congress to reform how the industry treats patients and controlls doctors and they have all been voted down. Why is it that one of the most basic needs of a civilization as great as ours is so flawed. If we can send people to the moon, build supercomputers, accomplish all the miraculous feats of genious and technology that we've accomplished , why is it we cannot provide basic healthcare for our citizens that created this great nation??? Sad times we are living in,,, God help us all because there is no one else left to turn to for help!!!

[Julie Pippert]

A true and honest look at the state of healthcare, and proves once again to boil down to exactly what you said about access and private v public. We owe every sick patient access to quality, humane and privacy-protected healthcare. So glad you wrote about this even while I'm so sorry you experienced it.

[Summer]

I'm sorry that you had to go through that. I've been without health insurance for years and it's sad that I've gotten so used to the hot, noisy, germ filled clinics that they seem normal to me. You ignore it unless it's going to kill you, and even then many just ignore it because what can you do.

[Daisy]

We had no insurance when my daughter was born. When my son was born, we were covered, thank goodness. He is disabled; blind from birth. It is unthinkable that McCain thinks "everyone" can afford health insurance. The sad story you told is much too true, much too common.

[Debbie]

Glennia, thank you so much for putting this story into a post. It's horrible that you had to experience it once, and even more horrible that others of us go through it whenever they (or their family) require care.

January of 09 canNOT get here too soon.

[Bob Schellenberg]

Get well soon, Glennia. What a hellish experience. Don't ever let anybody teach our children that this is the richest country in the world with the highest standard of living. Good luck with your recovery. We need your voice. Your brother-in-law.

[A Concerned Nurse]

Your post concerns me as both a Democrat and as an experienced RN.
I work in the public health care sector, in one of those stinky, full waiting room types. Although you say you weren't intending to indict that particular hospital, that's precisely what your post did.
The truth is, doctors and nurses work in places like those because they DO care. We can work elsewhere for a whole lot more money, but choose to staff these hospitals day in and day out because we want to help those who really need help - the uninsured, IN SPITE of the mess of a health care system that we have to deal with day in and day out. We show up and we care.
Also, if you do a little research, you'll find that Denver Health is a model safety net hospital in the country, and that many other hospitals nationwide try to be more like them in their broad access to care. Your one day in the urgent care clinic (also during a crazy week in the city which I'm sure displaced many of the working poor in the city and the staff had to work long hours to cover) is hardly a representation of the system as a whole.

I agree with your points that health care needs a serious overhaul and the difference between the have and have nots in this country is sickening. But you could have made those points without being so nasty and hurtful to the staff who may read it. Please remember that there are a lot of people who have dedicated their careers to the poor and disenfranchised.
And some free medical advice: WebMD will almost always be alarmist... and usually wrong.

[Andy]

Um... am I missing something here? Did I just read this and completely miss the connection between the story and the conclusion?

You went to a publicly funded health care provider and was treated like the name and number that you are to someone who isn't paid by you. Then went to a private care provider and was treated like a valued customer by the people you were paying.

Then your solution is to publicly fund all of them in a national health care plan, so we all can be treated like crap? What part of this am I missing. You should be against a publicly funded system that is horrible, not supporting it's expansion across the country.