Former US Surgeon General Criticizing $5,000 Emergency Room Bill

Business Insider is reporting that Dr. Jerome Adams, US surgeon general from 2017-2021, is complaining about the $5,000 bill after treatment at the Mayo Clinic Arizona emergency room (ER) for dehydration (1).

Figure 1. Dr. Jerome Adams former surgeon general of the United States and currently Director of Health Equity Initiatives at Purdue University.

Local media has been slow to pick up on this story with none of the local television, radio, or newspaper sources reporting on the former surgeon general’s ER visit. Adams first shared his experience on X (formerly Twitter) in a post that went viral. In an interview conducted February 26 with Business Insider, Adams said he was taken by ambulance to the ER in January after becoming lightheaded while hiking. He had labs drawn, received 3 bags of intravenous fluid and was discharged. The shock came when he received the bill. He decided to fight and has been spending hours on the phone with hospital billing reps to get a clearer picture of why he was charged so much. The bill likely will climb higher since Adams has not been billed for the ambulance that took him to the ER. Adams said the experience has been "mentally taxing".

It's unclear why Adams' bill was so high since he said he had not received a breakdown of the charges. ER bills are notoriously expensive and can vary drastically from hospital to hospital. Adams said he was billed for a Level 5 visit, which is a code used for patients with the most complex and highest level of severity, such as chest pain or stroke symptoms. Level 5 visits fetch higher payments because they require more resources and time. Adams said he was fighting the bill because he believed his visit should have been coded at a lower level.

Another issue is that Adams is enrolled in a $7,500 deductible health plan. High-deductible plans have become more common as employers have shifted the cost of medical care to their workers. A survey by Kaiser Family Foundation (KFF) found the average annual deductible for individuals in one of these plans attached to a health savings account was $2,518 in 2023.

Adams said that with all these obstacles, it was no wonder many Americans ended up with medical debt. "If I'm in this situation with my knowledge and with my financial resources and with my bully pulpit, then the average Joe doesn't stand a chance. The system is just broken", Adams said. Medical debt is a widespread problem. An analysis by KFF and the Peterson Center on Healthcare reveals that 20 million people in the US owe medical debt, and 14 million people owe $1,000 or more. Research has shown that medical debt is a leading cause of personal bankruptcy (2).

Congress has provided some relief from unexpected medical bills. The No Surprises Act, which went into effect in 2022, is supposed to keep patients from getting stuck with a surprise bill if they inadvertently receive care from an out-of-network doctor but does not cover a situation similar to Adams’. Adams said patients should have a better sense of what they'd be required to pay ahead of getting care and more clarity about their options when they get a big bill. He also said, “patients shouldn't face drastically different costs for the same care at different facilities. People are so scared of these bills due to lack of transparency. They actually just don't go in at all until it truly does become an emergency. There are many flaws in the system that would've caused other individuals to have gone into debt, have their credit ruined, or have to make choices about things they needed to do. I've got three high schoolers, two kids heading to college. If I wasn't in my income bracket, I might be making a choice as to whether or not to pay my medical bill or to pay my kid's tuition”.

Richard A. Robbins MD

Editor, SWJPCCS

References

1. Shelby Livingston S. A former US surgeon general says he went to the ER for dehydration and ended up with a $5,000 bill. He called the healthcare system 'broken.’ Business Insider. Feb 27, 2024. Available at: https://www.businessinsider.com/former-surgeon-general-medical-bill-shows-broken-healthcare-system-2024-2 (accessed 3/4/24).
2. Himmelstein DU, Warren E, Thorne D, Woolhandler S. Illness and injury as contributors to bankruptcy. Health Aff (Millwood). 2005 Jan-Jun;Suppl Web Exclusives:W5-63-W5-73. [CrossRef] [PubMed]

Cite as: Robbins RA. Former US Surgeon General Criticizing $5,000 Emergency Room Bill. Southwest J Pulm Crit Care Sleep. 2024;28(3):34-35. doi: https://doi.org/10.13175/swjpccs014-24 PDF 

Nurses Launch Billboard Campaign Against Renewal of Desert Regional Medical Center Lease

The California Nurses Association and National Nurses United have launched  a billboard campaign against the lease renewal of public-owned, Palm-Springs-based Desert Regional Medical Center to Dallas-based Tenet Healthcare (Figure 1) (1).

Figure 1. National Nurses Union billboard off Highway 111 West of Palm Springs near the I-10.

The billboard campaign is in response to the posting of two videos that showed a water leak in Desert Regional's neurological intensive care unit and an infestation  of cockroaches in the emergency department break room (2,3). Desert Regional is a public hospital governed by an elected district board. Tenet Healthcare is a private company that leases and runs the hospital. The nurses’ union said Tenet has a long-standing practice of short-staffing Desert Regional, which they said has caused patient safety issues (1). Tenet is currently in the process of renegotiating another 30-year lease with the hospital, which would include the option to purchase the hospital from the Desert Healthcare District at the end of the new lease (1).

Desert Care Network — composed of Tenet-operated hospitals Desert Regional, JFK Memorial in Indio, CA, and Hi-Desert Medical Center in Joshua Tree, CA — provided the following statement: "The California Nurses Association continues to spread misleading information about Desert Regional. These claims are unwarranted, and these tactics will not change Desert Regional's unwavering commitment to the Coachella Valley. Our hospital takes maintenance and cleanliness standards seriously. This includes addressing repairs needed due to people flushing non-flushable cleaning wipes or issues after heavy rains such as pest control. Consistent with sound operational protocols, we proactively closed areas for a short time to remediate issues. These unrelated occurrences were addressed immediately and disclosed promptly to the staff and the Desert Healthcare District" (4).

Desert Regional’s governing Board of Directors are elected to four-year terms by Palm Springs voters. No statement has been made to date by the Board or have any statements been made by state healthcare inspectors such as the California Department of Health  or national healthcare inspectors such as the Joint Commission and Centers for Medicare & Medicaid Services. Although lack of cleanliness does not necessarily equate with lack of quality, cleanliness if often used as a substitute measure for safe healthcare, much like restaurant cleanliness is used as a measure for safe food.

Richard A. Robbins MD

Editor, SWJPCCS

References

1. Tayor M. California nurses use billboard to voice opposition to hospital sale. Becker’s Hospital Review. February 29, 2024. Available at: https://www.beckershospitalreview.com/nursing/california-nThe urses-use-billboard-to-voice-opposition-to-hospital-sale.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=6133H6750001J5K (accessed 3/2/24).
2. National Nurses United. Ceiling Leaks in Neurological ICU at Desert Regional Medical Center. February 24, 2024. Available at: https://vimeo.com/914927727?share=copy (accessed 3/2/24).
3. National Nurses United. Cockroaches at Desert Regional Medical Center. February 24, 2024. Available at: https://vimeo.com/914925049/f9d46c5890?share=copy (accessed 3/2/24).
4. Sasic E. Desert Regional nurses launch billboards to spotlight concerns; hospital pushes back. Palm Springs Desert Sun. February 27, 2024. Available at: https://www.desertsun.com/story/news/health/2024/02/27/desert-regional-nurses-launch-billboard-campaign-palm-springs-area-hospital-news/72752162007/ (accessed 3/2/24).

Cite as: Robbins RA. Nurses Launch Billboard Campaign Against Renewal of Desert Regional Medical Center Lease. Southwest J Pulm Crit Care Sleep. 2024;28(3):32-33. doi: https://doi.org/10.13175/swjpccs013-24 PDF

$1 Billion Donation Eliminates Tuition at Albert Einstein Medical School

Albert Einstein College of Medicine in the Bronx joins NYU Grossman School of Medicine in becoming tuition free. Einstein’s tuition was eliminated by a $1 billion donor gift from Ruth Gottesman EdD (1). Dr. Gottesman, a retired clinical Professor Emeritus of Pediatrics (Developmental Medicine) at Einstein, has been a specialist in learning disabilities at the school since 1968 and is currently Chair of the Einstein Board of Trustees and also serves on the Montefiore Health System board. Announced to the cheers of the assembled student body, Dr. Gottesman announced that beginning in August, tuition will be free "in perpetuity". Tuition at the school is nearly $59,000 per year, leaving nearly 50% of the students owing more than $200,000 after graduating.

Dr. Gottesman’s fortune came from her husband, David "Sandy" Gottesman an early investor in Omaha, Nebraska-based Berkshire Hathaway, Warren Buffet's multinational conglomerate. Mr. Gottesman died in September 2022 at the age of 96 leaving his widow with a large stock portfolio and instructions to “do whatever you think is right with it”.

The gift evolved from Dr. Gottesman’s close friendship with Dr. Philip Ozuah, the pediatrician who oversees the medical college and its affiliated hospital, Montefiore Medical Center (Figure 1).

Figure 1. Dr. Philip Ozuah and Dr. Ruth Gottesman.

In early 2020, the two sat next to each other on a 6 a.m. flight to West Palm Beach, Fla. It was the first time they had spent hours together. They spoke about their childhoods — hers in Baltimore, his, some 30 years later, in Nigeria — and what they had in common. Both had doctorates in education and had spent their careers at the same institution in the Bronx, helping children and families in need. During the COVID-19 pandemic, Dr. Gottesman’s husband became ill with the virus. In the weeks that followed, Dr. Ozuah began making daily house calls — in full protective gear — to check in on the couple as Mr. Gottesman recovered.

Dr. Gottesman and Dr. Ozuah’s friendship and his commitment to assisting his patients even in threatening times likely led Dr. Gottesman to her amazing contribution. Dr. Gottesman said that not only would future students be able to embark on their careers without the debt burden, but she hoped that her donation would also enable a wider pool of aspiring doctors to apply to medical school. “We have terrific medical students, but this will open it up for many other students whose economic status is such that they wouldn’t even think about going to medical school,” she said.

Richard A. Robbins MD

Editor, SWJPCCS

Reference

1. Goldstein J. $1 Billion Donation Will Provide Free Tuition at a Bronx Medical School. NY Times. February 26, 2024. Available at: https://www.nytimes.com/2024/02/26/nyregion/albert-einstein-college-medicine-bronx-donation.html (accessed 2/27/24).

Cite as: Robbins RA. $1 Billion Donation Eliminates Tuition at Albert Einstein Medical School. Southwest J Pulm Crit Care Sleep. 2024;28(2):24-25. doi: https://doi.org/10.13175/swjpccs011-24 PDF

Kern County Hospital Authority Accused of Overpaying for Executive Services

Becker’s Hospital Review is reporting that the Bakersfield, CA-based Kern County Hospital Authority, is accused by the local employee union of overpaying two private firms that provide its top executives (1). The union alleges that Cantu Management Group and Meridian Healthcare Partners - both based in Bakersfield - have exceeded contractual amounts by 40 percent to 147 percent, leading to $23 million in overpayments over the past four years. Andrew Cantu of Cantu Management Group is also the CFO of Kern County Hospital Authority and its management representative for independent audits. Russell Judd served as the hospital's CEO until December 2021, and remains president and owner of Meridian Healthcare Partners.

A 9-page report alleges the hospital failed to disclose management compensation accurately, to properly correct the issue when notified,  and attempted to conceal the overpayments.  The union claims to have repeatedly brought questions about the hospital's financial management to the hospital and received "no substantive response." The union hired Scott McHone, a certified forensic accountant, to better understand the financials alongside their investigative team.

The union report indicates that Meridian Healthcare Partners was overpaid. Mr. McHone and the investigative team found that invoices filed with the California Department of Health Care Access and Information show the hospital paid the firm $39.9 million, although the union says the invoices it received documented only $19.3 million. The day after the union requested these payment records, the hospital's legal department took action to remove Meridian's name from financial disclosures, according to the report.

Kern County Hospital Authority denies all allegations. The hospital further stated that the services offered have been beneficial to patients, but did not directly comment on the compensation discrepancies.

Richard A. Robbins MD

Editor, Southwest Journal of Pulmonary, Critical Care & Sleep

Reference

1. Kayser A. California Hospital Accused of Overpaying for Executive Services. Becker’s Hospital Review. June 28, 2023. Available at: https://www.beckershospitalreview.com/compensation-issues/california-hospital-accused-of-overpaying-for-executive-services.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=6133H6750001J5K

Cite as: Robbins RA. Kern County Hospital Authority Accused of Overpaying for Executive Services. Southwest J Pulm Crit Care Sleep. 2023;27(1):7. doi: https://doi.org/10.13175/swjpccs029-23 PDF

SWJPCCS Associate Editor has Essay on Reining in Air Pollution Published in NY Times

Dr. Dona Upson

Dona Upson MD, an associate editor of the SWJPCCS from Albuquerque, recently had a Guest Essay published in the NY Times (1). In the opinion piece titled “The Government Is This Close to Reining in Some of the Worst Air Pollution” Dr. Upson states that the science is clear that when oil and gas are extracted and transported from wells, methane and other pollutants, including volatile organic compounds, leak out. These form ozone and may exacerbate asthma and COPD, cause cancer and birth defects, and affect the nervous system. Emissions from oil and gas production also produce nitrogen oxides, which can exacerbate lung disease. Methane is also a powerful greenhouse gas, over 80 times more potent than carbon dioxide in its warming power, though its life span in the atmosphere is much shorter. One of the fastest and cheapest ways to reduce these emissions and improve health is to prevent methane leaks, venting and flares, which would also go a long way in reducing ozone pollution.

According to Dr. Upson the federal government has a huge opportunity to reduce methane emissions, improve health and slow climate change. The first and most important way is through a rule proposed by the Environmental Protection Agency (EPA) to cut pollution, including methane, from new and existing oil and gas operations nationwide. Outside of the EPA the Bureau of Land Management has proposed a rule to limit venting, flaring and leaks of natural gas on public lands. Dr. Upson argues in her essay for support of both these rules.

Reference

1. Upson DJ. The Government Is This Close to Reining in Some of the Worst Air Pollution. NY Times. March 14, 2023. Available at: https://www.nytimes.com/2023/03/14/opinion/air-pollution-oil-gas-methane.html?unlocked_article_code=LsW56AyPBUFnQsdIIrFwy1HaNHxISpGdOo0FpzCnqqqP1YfKdSWQWrYoynSV01-SQEQyrA5w2wi-sVQGEROE0EwLWjE-3BChLi8DB4Oe5oxhLRyMnMMG7MpddaOr7EGGc_U-aqOX8XbiFd65ISJze9VOeElVgCqstnghXBz6Q2-H0DE1GBXPOniX-vrTep6gnAwAykHSM8zOkCBLmW95ctQT6HSKVyDO9ucEUFkvD_3njOYXmq6eCS4ZajhnvvO02qZQ2kUnw8E8bu72-MBdexXamik2wvUkk7gtc_nJMaVWhHiBLWGV33W2EE635C8xGF9TLtA0MvjDNm4mdYsq1-iP6O4Jqkw&smid=em-share (accessed 3/28/23).//

Cite as: Robbins RA. SWJPCCS Associate Editor has Essay on Reining in Air Pollution Published in NY Times. Southwest J Pulm Crit Care Sleep. 2023;26(4):59-60. doi: https://doi.org/10.13175/swjpccs017-23 PDF