By Consumers for Quality Care, on November 15, 2017
A recent Chicago Tribune article examined the lack of accountability from hospitals and doctors related to complications. These unforeseen costs can be extreme and often become the patient’s responsibility.
Whether because of mistakes, infections or plain bad luck, those who go in don’t always come out better. More than 400,000 Americans die annually in part because of avoidable medical errors, according to a 2013 estimate published in the Journal of Patient Safety. In 2008, the most recent year studied, medical errors cost the country $19.5 billion, most of which was spent on extra care and medication, according to another report.
By any calculation, unforeseen complications from treatments, procedures, and surgeries are not rare.
When things like this happen, questions arise: Who’s responsible? If treatment makes things worse – meaning that a patient needs more care than expected — who pays?
Consumers often bear the burden of these complications.
Charles Thomason went to the hospital in July 2011 for a routine colonoscopy. In the middle of surgery, Thomason’s doctor came to speak to his wife, Ann. Thomason’s colon had been punctured and he needed emergency surgery. Thomason almost did not survive the surgery. He now relies on a pacemaker and his heart problem resulted in the loss of his specialized drivers license, his job, and his health insurance. Without the insurance or disability benefits, the couple paid $600,000 out-of-pocket and struggled to pay for follow up care and routine bills.
There’s no single rule for how hospitals handle the cost of care when patients have bad outcomes and fault is disputed, said Nancy Foster, vice president of quality and patient safety at the American Hospital Association.
When situations like Thomason’s occur, the next steps are often complicated. If complications arise due to negligence, a medical malpractice suit may be possible, though it can be hard to get attorneys to take malpractice suits they are not sure they will win. John Goldberg, a Harvard Law professor, says this leaves many cases not adjudicated:
“We’ll never know if something has happened because of malpractice,” he said, “because it’s not financially viable to bring a lawsuit.” That leaves the patient responsible for extra costs.
Some hospitals have implemented protocols where they pay for follow up care for complications where the hospital is at fault. In these cases, the hospital admits its guilt and patients are told right away something that happened that should not have.
However, this is not an industry standard. When some hospitals inform patients of complications, they do not admit any guilt, instead calling the situation “unavoidable,” leaving the patient to pay the consequences.