This is a true story that’s happening right now in a hospital in Rhode Island.
A strong, 81-year-old man who worked 10-hour days was hit by a car while crossing the street on his way home from the restaurant where he worked. The driver, a Brown University student, said he was distracted by GPS, but some suggested he was talking on a cell phone. The man suffered severe, life-threatening injuries that left him temporarily paralyzed from the waist down and on a ventilator. Surgeons at Rhode Island Hospital saved his life. He later regained control of his limbs and recovered enough to be taken off the ventilator.
At that point, about a month into his hospitalization, he was supposed to be transferred to a rehabilitation hospital where he would have had the expected outcome of a fairly complete recovery, something he so desperately hoped for. But a series of crazy bureaucratic reasons prevented him from being transferred to rehab at that point. (He had no papers, no insurance, he doesn’t speak English but his family speaks it pretty well, the lawyer they found for him didn’t know how to get his rehabilitation paid for by the student’s auto insurance company, the hospital refused to release his medical records, which was completely illegal, and no one knew how to convince them, etc.)
So he remained in the hospital, where he remains today, with his mounting hospital bills, probably over $4 million, paid for with public funds. I will write more about this in the coming weeks, but it is not the subject of this commentary.
The single most important medical intervention that was needed to save his life while he was stuck in the hospital was and still is physiotherapy, lots of physiotherapy. He needed 3-4 hours of physiotherapy a day, and he craved it. But he didn’t get it, and he still doesn’t get it. The hospital had all kinds of excuses: not enough physiotherapists. They don’t do rehab in the hospital. To do rehab you have to go to a rehab hospital. He became disoriented and couldn’t cooperate with physiotherapy (like when he got a hospital acquired infection that went undiagnosed for 5 weeks, or when he said he was in pain but was overdosed on pain medication by people who didn’t speak his language and didn’t know his culture), etc. So he was denied the only treatment in the hospital that could have possibly gotten him well enough to be discharged, and without it he would very likely slowly die.
So the family found a doctorate-winning physical therapist in Rhode Island who would come to the hospital every day to treat their son. The woman started the treatment, but after a few days, the hospital asked her to stop.
What? There was one treatment that would have allowed him to recover well enough to be discharged, one treatment that might have actually saved his life, one treatment that the hospital itself did not provide but that his family found a way to take him to, and the hospital ordered that treatment to be discontinued? Yep, that’s exactly what happened. To make matters worse, the hospital’s decision was appealed internally. The matter was referred to the Attorney General’s office and the Ministry of Health, but no one thought they had the power to force the hospital to get a licensed and skilled physiotherapist to provide a vital and potentially life-saving treatment that the hospital itself could not provide. What on earth is going on?
What is happening is that medicine has been taken over by bureaucrats, administrators and lawyers who only know how to protect themselves and their organizations (some say make money), know nothing about medicine and yet are emboldened to make decisions that cost patients’ lives.
The hospital said that the physical therapists could not treat the patients because they were not employed by the hospital and were not licensed, and they recognized that they could be held liable if something went wrong. They were concerned that they could be sued if the patient’s condition deteriorated and that deterioration was linked to the actions of the outside physical therapist. (The hospital does not seem to be concerned about liability if the patient’s condition continued to deteriorate because they were unable to provide the necessary physical therapy and did not make any effort to ensure that the patient received the rehabilitation that he so desperately needed. Just to be clear.)
In a narrower sense, some of the hospitals’ arguments may actually be true — the way we’ve structured liability laws and regulations may create potential liability — but in a broader sense, isn’t a hospital’s primary responsibility to save lives? That raises the question: Who is responsible?
Once upon a time, hospitals were run by nurses and doctors, and existed for the care of patients, not for legal defense. Somehow, over time, administrators took control. First, they got rid of the private nurses who could provide the best care to patients (although they weren’t that expensive back then, but only for those who could afford it). Second, they got rid of the attending physicians who came to the hospital every day to check on patients and make sure disasters like the one described here didn’t happen.
Hospitals are now small businesses. They have large billing departments and full-time lawyers. About a third of the employees are doing billing, transferring funds, and attending meetings. Patient care is still done, but now legal defense and administrative management take priority, not patient care.
What could be crazier than that?
