A man calls 911 from a pay phone in a park because he is having bad chest pains.
The local fire department rescue squad takes him to a hospital emergency room where they determine he is having a massive heart attack and needs emergency bypass surgery. The operation is a success, and the man survives.
But during this ordeal he absolutely refuses to identify himself. He refuses to give a name or sign any forms with anything but an “X”. He also has no ID on his person. No one in the hospital has ever seen this man before. He states that he has no money and no insurance.
Has a situation like this ever come up? What did you do? The only solution I can think of is to call the police before he tries to leave and have him charged with absconding on this bill.
Don’t hospitals legally have to stabilize any patient that comes through the doors even if they can’t pay?
I have no idea if a bypass would be required in stabilizing a heart attack victim, but if it is, I assume they would do it. If there are other (cheaper) ways to stabilize him, I assume they would have done that instead.
Also, if he didn’t sign anything with his actual name or show any kind of ID or even tell anyone his name during this stay could he ever have given consent to this surgery? Can the hospital charge you for a procedure that you didn’t consent to?
Typically, he would be designated a John Doe with a number (John Doe #34 as the 34th JD admitted in that year.)
He would be treated as anyone else, money or not. If there is a charity hospital in the area, he might be transfered there once he’s stable.
Medical care isn’t predicated on ability to pay. Even Cedar Sinai, hospital to the stars, gives critical care to anyone who needs it.
Unidentified, comatose patients are patients. They get treated. They cannot be held against their will if they recover. It still isn’t illegal not to have your papers in most civilized jurisdictions. You own the hospital the money, and they can ask for police assistance if you attempt to abscond without making some arrangements for payment.
I once called the ER and asked, “What do I need to get a 12 lb. kid in status epilepticus admitted to your ER.” The doctor said, “The kid.” So, we went. I had no documentation of who she was, or if I had permission to have her treated. They took my word for it. The doctor told me that if he sees a patient in critical medical condition, and is there in the emergency facility, he MUST treat them.
I did spend about three hours filling out forms, though, while she was laying there with IV’s. Then her parents showed up, and started signing stuff.
There is a thing called medical identity theft, people use someone else’s name to get treatment. Because of that the hospital or doctor may ask for picture ID along with insurance card. If you are out cold I guess they can check your wallet.
Maybe a psych evaluation, to determine the source of his fugue state? Or a missing person’s report, image flashed on the news, to call on his family and friends to identify him? I know what the O.P.'s asking, but maybe everyone plays along until he slips up …
Patient: “Oh, I know who I am, I’m not confused or lost, I’m just trying to screw you on the bill.”
The O.P. makes it sound like someone can just purse their lips for days and days of interviews. I suppose it’s possible, if you’re tough enough, but if you’re tough enough, maybe that’s probable fraud?
And he’d receive the same care in the US as well. :dubious: Emergency situations are treated regardless of ability to pay, and you will receive a bill afterwards. Attempts will be made to set up payment plans, and at the hospital I work at, people with no insurance get a big discount on their hospital bill, plus a social worker can help you apply for any relevant government assistance, etc.
To the OP’s question: My WAG is that it’d be treated as an attempt to defraud, and the cops would be involved, but I really have no idea.
Yes. Something called EMTALA (Emergency Medical Treatment and Labor Act) requires most hospitals to provide an examination and needed stabilizing treatment, without consideration of insurance coverage or ability to pay, when a patient presents to an emergency room for attention to an emergency medical condition.
For our John Doe suffering an apparent heart attack, the available treatment will depend on where he’s taken. If they go to a “regular” ER, they’ll probably be stabilized medically, then a decision will be made on where to send him.
If they’re lucky enough to be taken to a facility with a cardiac catheterization lab, they’ll probably go straight from the ambulance to the cath lab for angioplasty. The current guidelines are “door to balloon” in under 90 minutes, and it’s a large matter of pride for a hospital to regularly have a shorter time - one of the local hospitals here boasts 60 minutes. Pausing the process to ask about insurance and ability to pay would only violate EMTALA and hurt their overall treatment speed stats.
Oh, as for who pays if our John Doe can’t? Most states and even larger counties will have indigent care programs to defray some of the costs that can’t be recovered from the patient.
Typically, these programs are funded from things like cigarette sales tax and civil penalties and fines. One-tenth of a percent (or whatever) of a parking ticket may not seem like much until you realize how many parking tickets get written.
The hospitals pay for it - that is, they pass the costs on to you. When EMTALA was enacted, the government neglected to include any mechanism of paying for it.
Heh, I was just teasing with my last post.
…though if we’re going to be precise about it, he’d receive the same emergency care in the US. Under UHC, he may receive additional, non-essential treatment.
…assuming he passes the death panel’s trials.
IIRC, non-profit hospitals have to provide a certain level of charity to retain their non-profit status/benefits, so some of that is typically included in cost reductions for those without insurance, and some in writing off bills that people can’t pay. Cost that is passed on is minimized by not having to make big profits for shareholders, but it does still have an effect.
Then there are public health institutions, like Stroger Hospital of Cook County (in Chicago; used to just be Cook County Hospital). They charge sliding-scale fees for county residents, all the way down to free. They’re also the major trauma center for the region. This is one of those things funded by taxes and so forth.
I’m not sure what service you get if you dial 911 in most countries. For example, for emergencies, you need to dial 112 is most European countries, 999 in the U.K., and 000 in Australia. (cite)
The big myth is that hospitals have an obligation to treat you. They don’t really. They have to stabilize you. I worked in reception in ER for three Chicago hospitals. None of them would treat you beyond getting you stabilized. Then it was out you go to Cook County.
And yes it was not unheard of for people to come in without ID. In my experience no one ever refuses to give a name. They just give a fake name and of course, “Can’t recall their SS# off hand.”
Hospitals don’t keep you around longer than they have to. My former boss had a stroke and the ambulance took her to Oak Park Hospital. Her insurance wasn’t accepted there. So after getting her stable they shipped her to Northwestern Hospital in Chicago (a much better place) as her insurance would pay for it. (Of course her insurance, covered the ER treatment at Oak Park, but it would only do so for till she was stable)
The other thing is ER will not do more. Cook County Hospital will treat you but that’s it. If you have an asthma attack they will give you a puff of the rescue inhaler and run tests, but that is all. They don’t give you a prescription for asthma medicine. The ER will refer you to free clinics (city sponsored and private) to get the long term treatments.
This is a big gripe for a lot of uninsured patients I know of. I know of one lady that has been to Cook County Hospital four times so far this year for asthma. I asked her why she doesn’t get a referral to a clinic and get an inhaler. She said, it takes too long to get into the clinics, they’re dirty and all she gets is a prescription she can’t afford to fill anyway.
So you can see how jacked up the system is. This lady can command the expense of an ER for something treatable like her asthma, when the ER could easily give her an inhaler and be done with it.
A co-worker of mine is on Badger Care, Wisconsin’s state run health insurance for low-income families. She pays nothing for anything health care related. To the point that she uses an Urgent Care as her GP because she doesn’t need to worry about appointments. I asked her if she could work late one day and she replied “Sure, I was going to take the kid to Urgent care tonight (Friday) for his cough, but I’ll just run him to the ER in the morning” I was surprised that she was so nonchalant about it and insisted that she take off and do what she needed to do and that’s when she told me that Dr’s, Urgent Care, ER, doesn’t matter, she doesn’t pay for any of it, so in that case, she’d rather work an extra few hours.
Her daughter has lupus and they diagnosed it and get treated by a combination of ER and Urgent Care visits. You’d think after a while the state would step in and tell her that she needs to find a regular doctor with regular office hours for something like this (lupus) where they’d be billing the state $50 per visit instead of $300. Especially since it’s non life threatening, but I guess then we have a whole slippery slope to deal with.
In the OP’s question, the patient required emergency bypass surgery, so that would be stabilization. In general any patient having a heart attack would would go straight to the cath lab for immediate angioplasty +/- stenting.
