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TEN THINGS YOUR HOSPITAL WON'T TELL YOU

1. "Emergency? Take a number."

Earlier this year Thelma Gundlach felt her arms go numb and her vision turn
fuzzy. She sensed a stroke coming on and had a friend rush her to the
emergency room at a hospital near her home in Modesto, Calif. Gundlach, 67,
expected to be seen right away. Instead, she waited four hours in an emergency
room jammed with other patients. Gundlach survived (her stroke was a minor
one), but now says, "It's unnerving to think about going back there."

Lots of other patients feel exactly the same way, Thelma. A 2000 study
conducted by the National Center for Health Statistics revealed that patients with
nonurgent problems (where life or limb are not at risk) wait an average of 68
minutes to be seen, up 17 minutes from 1997. "Generally, if you come in with a
chest pain, you'll get seen quickly," says Robert McNamara, chairman of
emergency medicine at Temple University Hospital in Philadelphia. Otherwise,
"you'll wait hours -- as many as 12, based on what I've seen."

While it's no fun thinking about getting hurt, McNamara suggests you do some
planning ahead for an injury or illness. For instance, scout around for an
emergency room with a fast-track area that will address minor complaints quickly.
"Also, if your emergency is not life or death," he says, "take a few minutes to call
and find the hospital with the shortest wait." And avoid getting seriously ill on
Mondays between 2:00 and 10:00 p.m. That's often the busiest time for
emergency rooms.

2. "We'll misdiagnose you to pad your bill."

Making patients wait in line is one thing. Purposely inflating the level of care
required to treat an illness (and jacking up the bill) is downright criminal. Just ask
Rick Newbold, a Center Bridge, Pa.-based physician turned high-tech whistle-
blower. Newbold employs a self-devised software program to reveal billing
inconsistencies. So far he's uncovered more than 100 hospitals he accuses of
hyping patient illnesses. He brought his findings to the attention of the U.S.
Attorney's office for the Eastern District of Pennsylvania, which to date has
helped recoup more than $15 million for Medicare, the usual victim of this
particular scam.

But it's not only insurers that suffer from this fraud. Jim Sheehan, an Assistant
U.S. Attorney based in Philadelphia, says such shenanigans by hospitals have "a
real impact on the public. It increases the expenses people pay, in taxes and in
health insurance." Unfortunately, patients and their families often have little
indication they're being used in this way.

3. "Our surgeons get confused."

Did you hear the one about the Florida woman admitted to a hospital with a brain
hemorrhage? The surgeon operated on the wrong side of her brain. Or how
about the Brooklyn hospital where an ophthalmologist mistakenly operated on a
patient's good eye?

These O.R. goof-ups would be laughable if they weren't so awful.


Euphemistically referred to as "wrong-site surgery," such mishaps have risen
from 16 nationwide in 1998 to 58 in 2001. To protect yourself from becoming a
victim of a directionless doctor, your first defense is avoiding incompetent
hospitals. The Joint Commission on Accreditation of Healthcare Organizations
does qualitative studies on health-care facilities across the country and posts its
results on its Web site, www.jcaho.org. Second, don't cut your surgeon too much
slack. Before you go under anesthesia, discuss with him exactly where -- and
why -- he wants to make incisions. Don't let him make a cut unless you're
completely satisfied with his answers
.

4. "You're not welcome here."

Hospitals should be egalitarian places. Exclusivity does not belong in the


operating room. Everyone deserves the best health care possible.

Sound reasonable? Perhaps, but patient advocates say it's not uncommon for
hospitals to delay or deny service if your health-insurance coverage fails to meet
its pricing standards. "If you have a major illness -- like heart disease or cancer --
you want to go to what I call a 'center of excellence,' a place with the best care
and most experience at treating your condition," says Ron Pollack, executive
director of Families USA in Washington, D.C., an advocacy organization for
health-care consumers. "But the first thing a hospital will do is biopsy your wallet
in order to figure out how you plan on paying. And if your insurance plan won't
pay everything they want, then the hospital will want you to put up the remaining
dollars."

Though hospitals are legally obligated to treat patients at risk of life or limb, none
are required to treat you after you have stabilized. Longer-term treatment -- at the
hospital of your choice -- with the wrong insurance policy will require a
persuasive argument. "Sometimes the insurance policies have appeal rights, so
under extraordinary circumstances, you can get yourself treated at a hospital that
does not seem immediately [welcoming]," advises Alwyn Cassil, spokeswoman
for the Center for Studying Health System Change, in Washington, D.C. "If the
physician responsible for facilitating your care says that you can't get appropriate
treatment within your existing network, that physician can be a powerful advocate
for you. Remember, it's best to know your appeal rights before you need to use
them."

5. "We partner with your doctor -- to commit crimes."

Physicians are expected to send patients to the hospital that can best treat their
conditions. In Kansas City, Mo., though, a pair of brothers, Drs. Ron and Robert
LaHue, were found guilty in 1999 of violating the Medicare Antikickback Act. They
accepted payments for regularly sending patients to Baptist Medical Center. In
addition to the brothers, a hospital official was sentenced to prison time.

Hospitals use more than money to induce doctors to send patients their way.
Some require physicians to bring a certain number of patients into the hospital
just to remain credentialed with them. "Some hospitals are giving kickbacks
rather than the best care," says Sheehan, the Assistant U.S. Attorney. He adds
that kickback crimes showcase an even more insidious element: "Your doctor
tells you that you need a certain treatment, you trust him, and you go for the
treatment. Most patients don't expect the hospital to pay him to make decisions
that may not be in their best interest."
6. "Don't trust us to keep your private life private."

Patient records are packed with sensitive information that you'd expect hospitals
to keep hush-hush. Tell that to a woman the courts call Jane Doe. Her uterus tore
during an abortion at Hope Clinic for Women in Granite City, Ill., in June 2001.
She was treated at Saint Elizabeth Medical Center. Days later her snapshot and
hospital record appeared on a pro-life Web site. Doe is suing Saint Elizabeth in
Illinois state court for failing to protect her medical records. "Somebody gave her
hospital records to [pro-lifers]," contends Doe's lawyer Mark Levy. (An attorney
for Saint Elizabeth declined to comment on the suit.)

While patients can usually request that information not be shared on internal
hospital networks or that a specific person be blocked from accessing reports,
hospitals "may or may not agree with your request," says Joy Pritts, senior
counsel of the Health Privacy Project at Georgetown University. While in office,
President Clinton issued rules that will require hospitals, starting in 2003, to get a
patient's written consent before releasing information to insurers, doctors and
pharmacists. The Bush administration, however, wants to change the Clinton
ruling so that hospitals would not need prior consent.

7. "And you thought you were coming here to get cured."

In the spring of 1998, Jill Cahill was admitted to a Syracuse, N.Y., hospital after
being brutally beaten by her husband, James. Six months later he went to the
hospital and finished the job (poisoning her with cyanide). Or consider this: In
April 2001, at Savannas Hospital in Port St. Lucie, Fla., a patient allegedly beat
to death three other patients and a nurse.

Such lowlights highlight the sticky middle many hospitals find themselves in when
it comes to security. "Most people like to see hospitals as an open environment,"
says Tony W. York of Hospital Shared Services, a Denver-based health-care-
services firm. "I like to see visible security people walking around on patient
floors." He also wants to see both employees and visitors wearing identification
badges at all times. Worried that an unwanted guest may pay a visit to your
room? York says, "The hospital should be willing to accept" a list of people whom
you don't want admitted. How well the hospital enforces it, he adds, is "a whole
other issue."

8. "Our skin banks get depleted -- just when you need them most."

In 1999 Sadie Nolan underwent a dozen operations at University of Wisconsin


Hospital and Clinics (UWHC) in Madison after being severely burned in a car
accident. Sadie was in constant danger of not getting the lifesaving skin she
needed. Two months later she died. Afterward, her mother, Kate, began to
wonder why there was such a shortage of donated skin. She says she was
shocked to learn that skin donated to Allograft Resources, the tissue bank
affiliated with UWHC, was unavailable. "It had moved on to a for-profit tissue-
engineering company," according to Kate. But Allograft President and CEO
Nancy Holland says, "We never received a call to help Kate Nolan's daughter."
UWHC spokeswoman Linda Brei acknowledges that the hospital did not have an
agreement with Allograft to receive skin tissue donated by its patients. She says,
however, that UWHC now uses a different tissue bank and is "contractually given
first priority on live skin." Still, there are hospitals without such reciprocal
agreements. Plus, Kate Nolan says many patients and their families are misled
when they decide to donate skin. She advises donors to "think about where you
want your skin to go. Write it out on a donor card. And make sure your family
knows."

9. "Need a doc? Don't we all."

America could use a few good surgeons -- stat. Largely as a result of rising
malpractice insurance costs, a surgeon shortage is affecting certain specialties.
According to a spokeswoman for the American College of Obstetricians and
Gynecologists, OB/GYNs in such states as Pennsylvania, Nevada, New Jersey,
New York, Mississippi and Texas are leaving the profession, fleeing to less
litigious states, or cutting back on high-risk procedures, such as obstetrics and
gynecological surgery.

"This problem is threatening our health-care system's ability to meet its


responsibility," says Ed Thompson of the Mississippi State Department of Health.
Currently, Thompson faces a dearth of obstetricians and neurosurgeons, and he
has set up a tracking system so that ambulance dispatchers can send drivers to
trauma units where neurosurgeons are available -- even though the length of
such trips may put patients in added danger.

10. "Your new organ has defects."

Most of the time a patient in need of a skin, organ or bone transplant can expect
the hospital to provide healthy body parts. Most of the time. But Tom Skinner,
spokesman for the Centers for Disease Control and Prevention in Atlanta, warns,
"We've been investigating bacterial infections found in people who've undergone
reconstructive knee surgery. These infections can be serious. One person has
died, and a number have become sick with infections."

While Skinner points out that half the infections can be traced to a company that
processes tissue used in reconstructive surgeries, Theodore Malinin, director of
the University of Miami Tissue Bank, says that if a hospital has a tissue bank, it
"is responsible for collecting" the tissue and it "should know how it has been
treated." Malinin suggests you ask your surgeon for "the maximum insurance of
safety" where bacteria may come into play. He says he not only conducts about
200 bacterial tests but will also run screens for various transmittable diseases
"even though many of them are not required by law."

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