Once Upon a Time in a Hospital
Last night on NPR’s "All Things Considered," Ted Robbins relayed the puzzling story of a patient at the University Medical Center in Tucson known only as “Adobe.”
UMC staff members have no idea who the man they call Adobe might actually be; the few belongings that were transported to the hospital with Adobe, among them a photo ID issued in Mexico, turned out not to be his. The predicament is that Adobe doesn’t know his true identity either, responding to almost any question with the single word “Cindi.”
The list of “facts” that UMC knows would fit in a Petri dish. Adobe was transported to UMC with a traumatic brain injury at the end of April following what must have been a horrific truck accident; four people died, 18 were injured and shuffled to various Arizona hospitals, and another 20 left the scene (Public service announcement: don’t get into what NPR describes as a “pickup truck” with 41 other people). All involved in the wreck were believed to have been illegal immigrants*. Adobe prefers to eat fish and melon. And for someone who can’t remember his own name, the question of health insurance is pretty much a moot point. There’s your Petri dish.
Were it not for the fact that the melodramatic aspects of this tale involve a living human being, Adobe’s story would be prime fodder for a cinematic treatment. An overloaded truck. “Foreigners.” A gruesome highway accident. A massive head injury. Amnesia. Caring medical staff. Ice Cream. An international quest for answers.
Were it not for the fact that UMC has to have spent hundreds of thousands of dollars—at minimum—caring for one patient who will more than likely never be able to reimburse the hospital for his care, it would be easy to forget that Adobe’s story is a worrisome parable for the healthcare industry.
The NPR report quotes a well-intentioned UMC nurse who remarks, “[Adobe] doesn’t have any family, so we’ve become his family.” Melodrama 1, Parable 0. The fact is, Adobe is not a member of that nurse’s family, nor is he the orphaned child of an anthropomorphized UMC. He’s a man with a serious brain injury who is unlikely to pay his escalating medical bills, whose life was saved by the medical arm of an organization while it’s other arm—the financial one—slits its own throat.
Adobe’s story is a melodrama and a parable. It’s soon to become a tragedy for one or both parties involved as well.
*It is my opinion that Adobe’s immigration status is immaterial to this story. Were he an American billionaire, insured to the eyeballs and in the same medical predicament, the financial implications for UMC would remain the same.
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Comment from [AMP] on August 14, 2008 at 3:47PM EST
Parable is an interesting word choice, since the definition is a story used to illustrate a moral lesson. Somehow, this seems more of a cautionary tale about not allowing compassion to come before the bottom line.
Now, what parables and cautionary tales often have in common is the narrator explains what should have been done differently, and why. I would be most interested to hear your suggestions and reasons.
Comment from uconnmike on August 14, 2008 at 6:34PM EST
Unfortunately his immigration status is very material to the story as well as the status of the other 22 dead or injured passengers. The cost to the local hospitals to treat these accident victims, aside from Adobe, must be enormous. Throw his bill into the mix, which I'm sure is in the ballpark of $1 mil or so, and you've got a financial disaster for these hospitals. Assuming that the other accident victims had no insurance, no id's, and no means to pay for the services they received you're looking at these hospitals, in tough enough financial times, eating about $1.5 mil.
With more strict immigration policies and enforcement perhaps this scenario could have been avoided. At the very least Adobe would have had some form of proper ID on him which the hospital could have used to locate his next of kin and quite possibly got him moved to an extended care or rehab facility in his own country.
Comment from harvey on August 19, 2008 at 11:45AM EST
uconnmike, I'm not sure what you think entails "more strict immigration policies and enforcement" over what is in place now. Besides the extensive fencing along the Mexico border there is a massive amount of technology and manpower employed to try and prevent illegals from entering border states. The other side of the supply/demand coin is the many American employers who ignore lack of status or actively look for illegals because they work for less and improve the bottom line.
You and I might believe we deserve a living wage or better for our labours yet we seem to do everything to avoid having to pay the price that would support living wages for these illegals who harvest our food, landscape our yards, build our renovations, etc. And we certainly don't want to pay more taxes than we have to, especially to support some form of socialized medicine that might remove the threat of bankruptcy from a hospital faced with this situation.
If I recall my stats, America has the highest medical spending per capita in the developed world with some of the worst results (life expectancy, infant mortality), since close to a third of the citizen population has no health insurance. That does not include the countless illegals. Sooner or later we all end up paying the tab.
Comment from FR. on August 19, 2008 at 2:28PM EST
Yes, the hospital will likely have write off the debt and I am sure there are a lot of similar cases like this. However the assumption that this only happens with accounts incurred by illegal aliens or that “they” do not pay their bills is wrong. I have been in healthcare collections for twenty years. Specifically emergency room claims and I can tell you that statistically we see a larger percentage of U.S. citizens who do not pay than illegal aliens do. We also receive more incoming calls and promises to pay as well as less broken promises from the bilingual accounts than from any other desk. The fact of the matter is that people assume that if one knows that they can get away with out paying their bill that they just won’t pay. What people do not realize is that if they were in the illegal alien’s situation and were in a country illegally and did not want to be discovered. But, then incurred an unexpected debt wouldn’t they make sure it was paid as quickly as possible so as to not raise any red flags? The fact is that the majority of people want to pay their bills and have good intentions. Those who do not pay because they can get away with it would do so regardless of where they are from or what country they live in.
Comment from Illlinois on August 20, 2008 at 1:38PM EST
A big question: Who is to decide to withhold medical treatment? Indeed who should have such authority? Furthermore, who has the right to grant such authority?
I understand the business considerations, but....
I know if I or a loved one is brought unconscious with a life-threatening condition to a hospital without any ID or health insurance card, I certainly would hope that immediate care would be provided without thought of any financial conditions.
Sometimes, maybe society bearing such costs as described in this case is just a price paid to be civilized.
Comment from Michael Klozotsky on August 20, 2008 at 2:08PM EST
Thanks for the comments!
First, let me say that blog/comment forums are a great vehicle for deeper dialogues, and I think each of you has made that point eminently clear.
Second, to AMP: your point is well taken... I need to think a bit more to determine what I think might be a better soluition--or a solution at all--to this morass. that said, in some ways I see my role in this system as an instigator rather than an ultimate arbiter. Said another way, if you've ever read the work of Jorge Luis Borges, even parables sometimes have murky, multiple meanings.
Finally, to uconnmike, I'm still sticking to my guns here about the irrelevance of Adobe's immigration status. His insurance/personal wealth status is much more important, in my opion, than the legality of his citizenship. Again, if the mystery patient was a white, 18 year-old kid from West Des Moines, IA, without financial resources and lacking insurance, UMC would be in the same pickle.
Comment from Michael Klozotsky on August 20, 2008 at 4:12PM EST
Also see this recent Chicago Trib article on essentially the same topic: http://www.chicagotribune.com/features/lifestyle/health/chi-patient-deportaug20,0,1937823.story
Best, MRK