Ten Things Your Hospital Won't Tell You

Lots of other patients feel exactly the same way, Thelma. A 2000 study conducted by the National Center for Health Statistics revealed that patients with nonurgent problems (where life or limb are not at risk) wait an average of 68 minutes to be seen, up 17 minutes from 1997. "Generally, if you come in with a chest pain, you'll get seen quickly," says Robert McNamara, chairman of emergency medicine at Temple University Hospital in Philadelphia. Otherwise, "you'll wait hours — as many as 12, based on what I've seen."

While it's no fun thinking about getting hurt, McNamara suggests you do some planning ahead for an injury or illness. For instance, scout around for an emergency room with a fast-track area that will address minor complaints quickly. "Also, if your emergency is not life or death," he says, "take a few minutes to call and find the hospital with the shortest wait." And avoid getting seriously ill on Mondays between 2:00 and 10:00 p.m. That's often the busiest time for emergency rooms.

2. "We'll misdiagnose you to pad your bill."
Making patients wait in line is one thing. Purposely inflating the level of care required to treat an illness (and jacking up the bill) is downright criminal. Just ask Rick Newbold, a Center Bridge, Pa.-based physician turned high-tech whistle-blower. Newbold employs a self-devised software program to reveal billing inconsistencies. So far he's uncovered more than 100 hospitals he accuses of hyping patient illnesses. He brought his findings to the attention of the U.S. Attorney's office for the Eastern District of Pennsylvania, which to date has helped recoup more than $15 million for Medicare, the usual victim of this particular scam.

But it's not only insurers that suffer from this fraud. Jim Sheehan, an Assistant U.S. Attorney based in Philadelphia, says such shenanigans by hospitals have "a real impact on the public. It increases the expenses people pay, in taxes and in health insurance." Unfortunately, patients and their families often have little indication they're being used in this way.

3. "Our surgeons get confused."
Did you hear the one about the Florida woman admitted to a hospital with a brain hemorrhage? The surgeon operated on the wrong side of her brain. Or how about the Brooklyn hospital where an ophthalmologist mistakenly operated on a patient's good eye?

These O.R. goof-ups would be laughable if they weren't so awful. Euphemistically referred to as "wrong-site surgery," such mishaps have risen from 16 nationwide in 1998 to 58 in 2001. To protect yourself from becoming a victim of a directionless doctor, your first defense is avoiding incompetent hospitals. The Joint Commission on Accreditation of Healthcare Organizations does qualitative studies on health-care facilities across the country and posts its results on its Web site, www.jcaho.org. Second, don't cut your surgeon too much slack. Before you go under anesthesia, discuss with him exactly where — and why — he wants to make incisions. Don't let him make a cut unless you're completely satisfied with his answers.

4. "You're not welcome here."
Hospitals should be egalitarian places. Exclusivity does not belong in the operating room. Everyone deserves the best health care possible.

Sound reasonable? Perhaps, but patient advocates say it's not uncommon for hospitals to delay or deny service if your health-insurance coverage fails to meet its pricing standards. "If you have a major illness — like heart disease or cancer — you want to go to what I call a 'center of excellence,' a place with the best care and most experience at treating your condition," says Ron Pollack, executive director of Families USA in Washington, D.C., an advocacy organization for health-care consumers. "But the first thing a hospital will do is biopsy your wallet in order to figure out how you plan on paying. And if your insurance plan won't pay everything they want, then the hospital will want you to put up the remaining dollars."

Though hospitals are legally obligated to treat patients at risk of life or limb, none are required to treat you after you have stabilized. Longer-term treatment — at the hospital of your choice — with the wrong insurance policy will require a persuasive argument. "Sometimes the insurance policies have appeal rights, so under extraordinary circumstances, you can get yourself treated at a hospital that does not seem immediately [welcoming]," advises Alwyn Cassil, spokeswoman for the Center for Studying Health System Change, in Washington, D.C. "If the physician responsible for facilitating your care says that you can't get appropriate treatment within your existing network, that physician can be a powerful advocate for you. Remember, it's best to know your appeal rights before you need to use them."

5. "We partner with your doctor — to commit crimes."
Physicians are expected to send patients to the hospital that can best treat their conditions. In Kansas City, Mo., though, a pair of brothers, Drs. Ron and Robert LaHue, were found guilty in 1999 of violating the Medicare Antikickback Act. They accepted payments for regularly sending patients to Baptist Medical Center. In addition to the brothers, a hospital official was sentenced to prison time.

Hospitals use more than money to induce doctors to send patients their way. Some require physicians to bring a certain number of patients into the hospital just to remain credentialed with them. "Some hospitals are giving kickbacks rather than the best care," says Sheehan, the Assistant U.S. Attorney. He adds that kickback crimes showcase an even more insidious element: "Your doctor tells you that you need a certain treatment, you trust him, and you go for the treatment. Most patients don't expect the hospital to pay him to make decisions that may not be in their best interest."