Well, probably mostly free. The guy may be able to pay some of his bill (but I doubt very much). Last night I had a young man, recently graduated from college with no insurance and only a part time poorly-paying job who came in after a stupid motorcycle accident. He was fooling around with no helmet in a parking lot at 15 mph and crashed into a metal wire fence. He broke his forearm and severely lacerated his face (just under his one nostril), and two fingers on his dominant hand (almost cutting his extensor tendons) , bruising his knee and shin,and got road rash on his other hand and leg. All told, I put in about 50 sutures, including deep ones. Splinted both fingers, reduced his broken radius as best I could and then splinted it, and cleansed off all his abrasions. It took me about 2 1/2 hours of work. A plastic surgeon or orthopod or other surgical specialist would have easily charged 10K for all of that work (who knows, maybe more!). I did it for free (well, as I said before, he may try to pay some of our bill but I don’t think we’ll get much). He was a good, nice kid (just did something stupid – and was not drinking) who was very thankful so I did not really mind. While I did this, the ER massively backed up even though there was another doc and a PA working. I would have LOVED to call someone in to help but I knew they would refuse since he had no insurance. The best I was able to do was to get the on call orthopod to see him in his office next week – where he will hopefully arrange for him to have his radius surgically fixed through the clinic system. I would love to tell them about cases like this that I don’t ask them to come in for when they balk about coming in for minor cases with insurance!
I can’t believe so much damage occurred while he drove 15 mph in a parking lot, sans a helmet, against a wire fence.
Was it chain link or titanium?
Sounds like you should have called in the specialist to handle the case and not backed the ER up so much. If this guy is not going to pay your bill, then why worry who else that he is not going to pay. If it was an MVA, it will go on auto insurance anyway and the specialist love it. Spread the wealth, and the work.
How many times have you called a plastic surgeon in for a laceration that you could have fixed in a matter of minutes just because your busy and its easier to have them fix the laceration? They can take one on the chin and suck it up for a nonpaying case once in a while. They charge $3000 just to fix and simple laceration that takes less than 20 minutes and when in the ER they can pick up a case or 2 if they are lucky, That makes it about a $9000 dollar payday when they come in. So it turns out to be $6000, big deal.
Next time ask them to come in a see the patient, and don’t worry about telling them about the insurance or tell them it was an MVA.
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Hmmm- the fence was a regular chain link fence that was coming apart so there were all kinds of sharp edges. The bike was uninsured as well – so no insurance at all. It was big (1100 cc) and it landed on top of him when he fell off it and crushed his arm. Luckily his face was just scraped against a sharp edge of the fence so he sustained no real head trauma.
I’d have been spazzing out if you worked on one case x 2.5 hours while everyone else had to wait when there were other choices available, especially a lac repair case where you can’t easily leave to eval anyone else. Don’t be the reimbursement martyr, TK.
I’m sure you’re on the nurses’ sh*t list now, BTW. You may need to buy donuts or pizza for the next week or two.
Thank you. As a patient (and I’ve been one more often than my fair share) I would far rather wait for someone like this young man than a chronic drug abuser or a stubbed toe or a cut on a finger. You done did some good there, sir.
The RN’s were annoyed Nurse K – but they understood – because he was seriously messed up. When he said he had no insurance, they all gave barely audible collective “sigh”. Actually, the plastic surgeon on call had just left after doing two complicated lacs on children WITH insurance. They knew there was no way he was coming back at 1am for this one…
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That sucks in so many ways.
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Wow lol. Only in America ER doctor brags about his “charity” work (e.g. actually helping a patient) like it is something out of this world.
You guys have one of the worst healthcare systems in the developed world – most inefficient and wasteful ,where both patients and doctors are dissatisfied. Which leads to former suing the sh1t out of the latter and latter whine incessantly
Wow Max.. I bet you’d love to work for free too after spending $200,000 on your job training. Idiot.
Ummm, Max. ER docs do this sort of thing ALL THE TIME. I am salaried so for the most part, individual cases do not affect my paycheque one way or the other. I posted this case to show what sort of thing we do – and although we may complain about it, we do it. Well paid subspecialists also do charity work – but would balk at this one since technically their work was not “required” – ie I was comfortable doing it and nothing like Parotid Gland injury, lid margin lac, or open fracture,tendon lacs occurred. And yes, I agree our health care system is an utter mess – something I hope the new administration will address. I am sure also that your healh care system also has it’s share of problems – if you come from the UK, Canada, or Australia, there are plenty.
Specialists usually aren’t very sympathetic to the excuse that we can technically fix it, but it will take a long time and the ER will get really backed up if we do.
Tough situation.
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