I have been less available for emergencies as of late, but got caught up in one recently. A young lady had been bitten by a pit bull and a portion of her nose had been removed. What followed was a three day run around partially due to the nature of the law and the health care system. Let me explain…..

Specialists like Plastic Surgeons are at times hesitant to see emergency patients as they represent poorly compensated or uncompensated liability. When we are even called to see emergencies our names are added to the medical record which immediately puts us in line for a lawsuit. If the care of that patient goes poorly, the law permits a lawyer to sue essentially any doctor’s name who appears on that patient’s chart. In addition, there are laws regarding the care of emergency patients that forbid a doctor from inquiring as to a prospective patient’s health insurance status when being called for an emergency. Essentially we cannot even try to insure we get paid for whatever care we render. And many emergency room patients are uninsured and do not pay their bills.

Even when patients do have health insurance, the nature of that health insurance and additional laws again slant the deck against the doctor. In California former Governor Arnold Schwarzenegger signed an executive order that a doctor could not balance bill a patient for anything an insurer did not pay on an emergency bill. So even if the patient is insured the doctor has no assurance of being able to get paid anything reasonable. The insurance plan pays what they want pretty much knowing that the doctor has little recourse. Thanks Arnold.

Back to my dog bite consultation: a 20 year old woman had a portion of her nose gnawed off by a dog. She needed surgery after the wound was allowed to heal for a few days and was discharged with wound care and follow-up instructions. My office interfaced with her insurer. It turns out that she had “Health Net administered Medi Cal.” Nearly a dozen phone calls from my office to her provider doctor were made. I had to write a letter to fax to them to indicate what she needed. We did this the day after her injury. The following day we received a phone call and a fax indicating that the patient had been re-routed to a provider doctor meaning one who takes her insurance. So at that point we had spent hours on the care of a patient who was sent to another surgeon by her insurer for her surgery. This work was all done without compensation of any sort.

This amounts up to a colossal waste of time and more potential liability: Would the patient get her surgery in time to minimize her deformity? Would I be liable for any deformity she might have even though her plan essentially took her away from me? I was not really interested about the amount that Health Net was going to pay anyway, but to receive any liability on a case like this is kinda ridiculous.

These are amongst the reasons that I like many other Plastic Surgeons have greatly curtailed my willingness to become involved in emergency cases. As my Grandfather used to say, everybody has to make a living.

Best Regards,

John Di Saia MD

Originally posted 2011-11-24 07:30:15.