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Your family member gets sick. They are badly sick, but they are also insured very well. So, they go into a hospital, usually a hospital near where they live--in this case, St. Luke's Episcopal Hospital in Houston, Texas. But, while they're in the hospital in Houston, they get sicker. Their insurance company, which has negotiated with the hospital, earlier in the year, to pay so much for patients in intensive care per day, begins squawking to the hospital. "Hey," they say, "We negotiated with you to pay $10,000 a day for patients in intensive care, but this one has been in WAY too long. We're going to cut you down to $7500 per day for these kinds of patients next negotiation if you don't do something about this patient that is costing us so much money." Either that, or the insurance company really plays hardball and says, "Hey, we're only going to pay you Medicaid rates on this patient, because she's been in ICU too long."
So, the hospital calls a meeting of the family and medical personnel. The family is usually intimidated by the white coats, all in one room, all in unison, saying, "Your family member is in pain, going to die, continuing treatment will only prolong their suffering." Usually, that's all it takes and the family says, "Okay, discontinue treatment." God forbid they have the audacity to continue to hope for their family member and decide to keep them alive, thereby using up even more precious insurance company money.
But, if they do, there's a contingency plan--the hospital calls an "ethics committee meeting." All the medical guys and gals get together and make a decision on whether or not to end care for the patient. This is SUPPOSED to be a time where the family can defend their family member and say that they have quality of life and why it's important to let them live. (Can you imagine? You're begging for your family member's life when these are the very people you entrusted that life to, in the first place!) Usually, though, it's doctors, "ethicists" (the latter of which have often never even MET your family member), social workers, nurses, palliative care people, etc., ALL on the hospital's staff, lined up against the family, rooting for withdrawal of treatment.
Oh wait! I forgot something: Right between the first meeting and the actual ethics committee meeting, there's another meeting. This one is called if the family doesn't agree to the withdrawal of treatment, ostensibly because they want to talk about pain medication for your family member. This is routine in cases where the patient is conscious and likely to speak out when the plug is pulled. You don't want a conscious patient, after all, fighting to stay alive, right? During this meeting the white coats decide that the patient is in "intractable" pain and they must medicate him/her into a comatose state. Seriously, no joke. If the family disagrees with the "medicate into oblivion" plan, they are overruled, but not before they are treated to a disgusting show of adversarial cross-examination by the head of the committee: "Did your sister TELL you she wanted to be in horrible pain?" If you can't answer "yes" to that strange question, then your family member will be duly medicated into oblivion.
So, the "ethics committee" meets. They hand down their decision to withdraw treatment. Now, you've got ten days to move your loved one, your very sick loved one, who shouldn't be moved, to another hospital which can give her all of the specialized care that the hospital that she is already IN can give her, but which refuse to, after ten days. If you don't move your loved one, the hospital can and will pull the proverbial plug, whether you like it or not. And you have no recourse, neither criminal nor civil, against them if they do.
Okay, now you've got to move your loved one. Well, of course, since the hospitals in the area are closer and your family can continue to visit their loved one if they stay in a hospital in the area, you try those first. But there's a problem: those hospitals, all of them, have agreements with each other--if one of them decides that a patient is "futile" then none of them will take that patient. So...if you move your loved one, you're going to move them far away, so it's very, very difficult to be able to visit with them. So, now you've not only got a very sick brother/sister/mother/child, you've got a situation where if they die, you will likely not be at their bedside to say goodbye to them. And that's if they survive the ride. Which, by the way, YOU will pay for out of your own pocket, and which costs tens of thousands of dollars because the insurance company doesn't have to pay for the transport of the patient in these cases. And the clock is ticking. Ten days, nine days, eight days, seven, six....
Now, according to the law, the hospital social worker, employed by the hospital--you know, the one who was fighting alongside the doctors during the ethics committee meeting to have treatment discontinued--is supposed to help you locate another facility both willing and able to take your loved one. Not only can you NOT talk to these facilities YOURSELF, but you are entirely dependent on this social worker to set this transfer up. In this, you must be very, very careful. Don't piss that social worker off; don't make her upset, or she will do like she did in our case and lie to you, give you misleading information ("if you find a facility, the doctor to treat your loved one comes with the facility and has to take on her care"), and if you dare to call her on it, she will refuse to speak with the family completely!
In the end, the best case scenario is that your loved one is moved out of state, where if they die, you cannot say goodbye to them, and if they linger, you bankrupt yourself visiting them. And this is the BEST case scenario; this is if your loved one is insured, has made their premiums for years and even decades, just so they could be covered in just such a case.
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