There is a clear trend going on in American healthcare. Day by day, there’s an erosion of healthcare decision-making out of the hands of patients, and even their doctors. Control is being wrestled away by Medicare and insurance companies who are more concerned about cost savings and profitability than patient safety.
As a former hospital administrator, I know that this isn’t a new trend and it’s one that’s affected all types of healthcare.
While it’s true that many patients are fine and may actually save money because of the cost-savings mandates, there are sadly others who pay the price with their lives.
To me, the question comes down to who you want to be there if something really bad goes wrong. Something like a respiratory or cardiac crisis or arrest.
Let’s talk about two areas of healthcare as examples.
Anesthesia care
In my experience, anesthesiologists are the type of people that you want at the bedside if something goes wrong. They have extensive and robust training in dealing with respiratory emergencies and restoring airways under stressful emergency conditions.
Third-party payers, though, don’t like the fact that anesthesiologists are highly compensated for their services. They joined with powerful nursing lobbyists to recognize certified registered nurse anesthetists (CRNAs) as substitutes for anesthesiologists in the operating room.
There is no doubt that they are less expensive than anesthesiologists. There’s also no doubt in my mind that patients have a much higher likelihood of surviving an intraoperative emergency if an anesthesiologist is at the bedside.
Because of Medicare and health insurance company cost-savings requirements, though, it’s highly unlikely that an anesthesiologist will be in the operating room for most surgeries. Instead, many anesthesiologists largely spend their days supervising or directing four or five CRNAs who are providing direct anesthesia care to four or five patients in four or five different operating rooms at the same time.
It doesn’t take much to imagine what could go wrong with this model. The anesthesiologist is supposed to be immediately available to respond to an emergency. But what happens when something goes wrong in two operating rooms at the same time?
From my experience handling many Texas medical malpractice cases, I believe that CRNAs are valuable parts of the operating room team who are competent to perform routine tasks. In many cases, CRNA competence ends at the exact moment that something starts going wrong.
Even when an anesthesiologist is immediately summoned to the operating room when there’s trouble, there is still an understandable delay. It takes seconds or minutes for the anesthesiologist to rush to the operating room. Upon arrival, it takes additional time to get briefed on what had happened before the anesthesiologist arrived and to make decisions about what to do.
During the informed consent process and pre-anesthesia evaluation, anesthesia providers typically keep patients in the dark. Patients aren’t told that the anesthesiologist won’t be in the operating room and that, instead, a nurse will be managing the anesthesia care.
Freestanding imaging centers
Another area of healthcare where insurance companies are making the call on where patients get treated is radiology.
Cigna recently joined other health insurance companies in mandating a new policy, effective on April 15, 2020, that dictates that its insureds must have most MRI and CT scans done at freestanding imaging centers instead of hospitals.
Cigna is touting its forced choice as a pro-patient move that could save over $1,000 of out-of-pocket expenses. There’s no doubt, though, that this move will generate a substantial cost savings to the insurance companies. One study suggests that an MRI or CT scan done at a hospital can cost nearly 150% more than the same scan being done at a freestanding imaging facility.
There are some exclusions from the new edict. Cigna will still approve MRI and CT scans at hospitals in the circumstances:
• Where the patient is 10 years old or younger
• Where the patient is a pregnant mother in obstetrical observation
• Maternal fetal medicine/perinatology services for high risk pregnancies
• Transplant patients
• Patients with contrast allergies
• When there’s no acceptable alternative site available
Generally, most people think of an MRI or CT scan as being risk-free, at least when it comes to life or death. Sometimes, though, that’s simply not the case, particularly when it comes to diagnostic radiology scans done under contrast.
A contrast agent is a chemical substance that’s administered to the patient before the scan is performed to enhance the ability of a radiologist to interpret damages. Some contrast agents are administered orally for swallowing, while others are pushed through an intravenous (IV) line.
Some patients may experience violent symptoms in response to a CT or MRI contrast agent. This is called an anaphylactic reaction and can lead to severe respiratory problems and even death.
That’s exactly what happened in a medical malpractice case that we filed on behalf of the wrongful death beneficiaries of a man in his 50s who had a routine CT scan with contrast at Gateway Diagnostic Mid-Cities, in North Richland Hills, Texas. He walked into the freestanding imaging center for an abdominal CT scan because of some kidney stones. He was taken out on a stretcher.
The standard of care requires freestanding imaging centers to have a radiologist or physician immediately available to respond to an anaphylactic emergency. Unfortunately, though, not all imaging centers operate that way. Sometimes, the only personnel on-site are radiology techs, who don’t have the training and licensure to respond to an airway or anaphylactic emergency. Further, some physicians who order scans and freestanding imaging centers do a poor job of screening patients for potential contrast allergies.
If you end up being sent to a freestanding imaging center for a radiology scan under contrast, it’s a good idea to talk with both your prescribing physician and the center staff about the potential for anaphylaxis. Ask if you have any concerning risk factors. Verify that a physician is on site and immediately available in case there’s an emergency.
If you or a loved one has been seriously injured because of contrast anaphylaxis, anaphylactic shock, or poor radiology care, then contact a top-rated experienced Houston, Texas medical malpractice lawyer for help in evaluating your potential case.
