Louisville Medicine Volume 69, Issue 5 - Page 31


If you got seriously injured , who would you want to respond and where ’ s the first place you ’ d want to go ? I , personally , would want an emergency responder to arrive on the scene , respond quickly and respectfully before taking me to a hospital , where I ’ d expect a team of doctors to rush me in , do everything they could to save my life and employ a team of medical staff that would take care of me until I was able to go home safely . I recently learned that this may be an unreasonable expectation in the current state of our health care system .




My daughter sustained a gunshot wound from a mishandled loaded revolver when the carrier discharged the weapon when reaching into his pocket where the weapon was being kept . The bullet entered her lower left back , travelling through her abdominal cavity and pelvis and lodging in her left thigh . EMS was summoned and cared for the perpetrator who had shot himself in the leg but missed that my daughter was shot , although she said she had been injured . The entrance wound was not discovered until she was examined at the hospital emergency room . Somehow , the EMS personnel felt she was not reliable and instead of providing care for her , mocked her for complaining of pain . They also assumed she was on drugs and laughed at her for speaking incoherently ( they mistook her cries of pain as broken English from a non-native speaker ) - neither of these was true .
Once the injury was found by the physicians , she underwent surgery to remove part of her small bowel and descending colon , then was transferred to the intensive care unit . At this point , I was finally contacted by the hospital , even though my daughter had told the hospital staff that her father was a doctor and my contact information was available in her pocket .
She spent 16 days in the hospital and had a wound VAC placed to improve closure of her open abdominal incision . As we were planning for her discharge , we worked with the discharge planner to find an appropriate and safe place for her to complete her rehabilitation . Things then went from bad to worse . Initially , the discharge planner said that one rehabilitation facility had accepted her post-discharge but within hours , the physician refused to accept her , as did another facility . We were not provided any reason why these two facilities would not accept her as a patient and were left to wonder whether it had to do with her having Medicaid health insurance , or her mental health diagnosis ( she has bipolar disease ), or that she is an Asian female .
Since we could not get her admitted to an acute rehab care facility , the hospital said she would be a candidate for subacute rehab or nursing home placement . At this point , the hospital discharge planner informed us that there was no Medicaid bed in such facility available anywhere in the entire state .
Without a rehab facility available , we then contacted home health agencies to provide in-home nursing services for wound VAC care . No home health agency in the area would accept her because she was a gunshot victim . Multiple discharge planners and trauma surgeons said that they cannot get home health agencies to see post-op gunshot wound victims because they fear their staff would be in danger and they would be liable . They refused , even though the event in this case was accidental and occurred nowhere close to where my daughter resides .
The hospital discharge planners said there was no option except to release my daughter home . Since she has Medicaid , they said that her insurance would not cover an aide to assist , and since we could not care for her at our house due to lack of first floor bedroom or bath , our only avenue was to pay out-of-pocket for an aide to help and provide transport services to multiple outpatient medical and therapy appointments .
Probably related to the lack of close medical supervision as an outpatient , my daughter had multiple falls at home . She developed sepsis from abscesses that developed in the bullet track requiring readmission to the hospital for another four days . At the time of the second discharge , the same issues arose trying to get care , and she was taken off IV antibiotics and sent home on oral antibiotics . Again , no rehab or nursing agency would accept . She was sent home with a self-pay aide who could not start until the third day at home ( there was limited availability with one of the few home agencies that accepts patients younger than 55 ).
Financial considerations appear to have become the major factors affecting medical care availability and not the rendering of good or adequate medical care . The health of the patient has become secondary to the financial goals of the institutions and agencies that are licensed to provide medical services to our state ’ s population . I was told repeatedly by multiple discharge planners that those institutions and agencies really did not have to provide any reason for denying services , so there was no way to appeal their decision .
From no fault of her own , my daughter has been a victim of gun violence and a health care system that does not appear to be concerned about patient safety . I asked the discharge planners what they would do if my daughter had no family to assist her , and had no way to pay for her in-home care . Would they just roll her out of the hospital and leave her on the street corner ? I did not get a response .
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