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Original Thread:  CLICK HERE 

TL,DR: Took daughter to ER because she was acting very strange in addition to cold symptoms.  She was given IV fluids for dehydration & sent home.  Hospital later called & told us to bring her back to the hospital immediately as they were seeing strep bacteria in her blood cultures.  She was hospitalized for several days for monitoring until a second set of blood cultures could be reviewed.  Second set came back negative, she was discharged.  I wasn't happy that she was "unnecessarily" hospitalized, though I did believe the doctors & hospital followed protocol & gave her the best possible care knowing what they knew.  After FWF input & given my feelings that she received top-notch care, my plan was to pay the bill & move on.

Since the conclusion of the prior thread, I received bills for her care at that time.  I didn't like the fact that they were charging us for 2 ER visits, since only one should have been an ER visit (when they called us to bring her back to the hospital after they discovered the bacteria in her blood cultures, they had us enter through the ER, but admitted her immediately & even had a team waiting for her when we arrived).  We complained about the second ER visit charge.  After the complaint, apparently the entire treatment was reviewed & the powers that be within the hospital sent us a $1,700 refund--the total of our out of pocket for the re-admission.  They stated in their letter that they believed that they followed protocol & provided appropriate care, but were issuing the refund as a courtesy.  We were really surprised by that, since we never complained about anything except for the second ER charge, which they never mentioned in the letter.  We will not be complaining about the larger than expected refund, of course.  I'm sure this will start an entire chain of events of other medical bills being re-billed (due to the $1,700 no longer counting towards annual deductible & out of pocket maximums), but I am pleased with the outcome none the less.  Once I see how it all shakes out in terms of  other medical bills being re-billed, we are likely to make a charitable donation to the hospital (in addition to our normal annual gifts to them) to clear our conscience.

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Psych: Harm isn't getting a medication to no ill effect. Harm is getting a medication and then getting anaphylaxis or ... (more)

DrDubious (Sep. 11, 2016 @ 9:44a) |

glitch - No, I don't think the hospital would face significant consequences if the OP 'raised a stink.' A lot would depe... (more)

psychtobe (Sep. 11, 2016 @ 1:04p) |

Psych, I think in your hypothetical the bigger concern is starting Clozaril as a first treatment when less risky choices... (more)

DrDubious (Sep. 11, 2016 @ 2:19p) |

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As always, FWF appreciates updates. Glad that this turned out better than expected.

You likely have a valid malpractice claim, which - win or lose - would cost the hospital far more than $1700 to defend.  That $1700 is as much hush money as it is a refund.

Should have gotten a 50% off your next ER visit. The Hospital Admins are amateurs.

I imagine the hospital still billed your insurance for the visit, and only wrote off your portion. If this is the case its highly likely that your insurance still thinks you were billed that amount, and that it still applies to your deductible.

Glitch99 said:   You likely have a valid malpractice claim, which - win or lose - would cost the hospital far more than $1700 to defend.  That $1700 is as much hush money as it is a refund.
This issue was heavily debated in the original thread.  After those responses & after doing some research on the issue of blood sample contamination, I don't think there's a chance in hell that the courts would possibly consider this malpractice. Sample contamination is extremely common & at the end of the day, I'm glad that they erred on the side of caution with my daughter's treatment.  The end result is that we were inconvenienced, my daughter received unnecessary antibiotics & the hospital stay cost a little money.  Nobody was hurt, and as a father of 3 (all born prematurely and all received care from this hospital after birth) I'm thankful that my community has such a strong children's hospital available to us.

No personal experience with any of this, or much to contribute, but wanted to say thanks OP for not being a litigious ass about the whole experience.

daw4888 said:   I imagine the hospital still billed your insurance for the visit, and only wrote off your portion. If this is the case its highly likely that your insurance still thinks you were billed that amount, and that it still applies to your deductible.
 I hope you're right!

raringvt said:   
Glitch99 said:   You likely have a valid malpractice claim, which - win or lose - would cost the hospital far more than $1700 to defend.  That $1700 is as much hush money as it is a refund.
This issue was heavily debated in the original thread.  After those responses & after doing some research on the issue of blood sample contamination, I don't think there's a chance in hell that the courts would possibly consider this malpractice. Sample contamination is extremely common & at the end of the day, I'm glad that they erred on the side of caution with my daughter's treatment.  The end result is that we were inconvenienced, my daughter received unnecessary antibiotics & the hospital stay cost a little money.  Nobody was hurt, and as a father of 3 (all born prematurely and all received care from this hospital after birth) I'm thankful that my community has such a strong children's hospital available to us.

  But it is something you could raise a stink over, and while you may or may not "win" it is a legit complaint.  $1700 is worth avoiding that headache (and the costs of that headache) by ensuring you are satisfied.  I may have been a bit crass with my first response, but this refund is more than just a mere courtesy out of the goodness of their heart.  It is to their credit for being proactive about it, and not waiting for it to get nasty before trying to settle, like is so common these days.

Glitch99 said:   
raringvt said:   
Glitch99 said:   You likely have a valid malpractice claim, which - win or lose - would cost the hospital far more than $1700 to defend.  That $1700 is as much hush money as it is a refund.
This issue was heavily debated in the original thread.  After those responses & after doing some research on the issue of blood sample contamination, I don't think there's a chance in hell that the courts would possibly consider this malpractice. Sample contamination is extremely common & at the end of the day, I'm glad that they erred on the side of caution with my daughter's treatment.  The end result is that we were inconvenienced, my daughter received unnecessary antibiotics & the hospital stay cost a little money.  Nobody was hurt, and as a father of 3 (all born prematurely and all received care from this hospital after birth) I'm thankful that my community has such a strong children's hospital available to us.

  But it is something you could raise a stink over, and while you may or may not "win" it is a legit complaint.  $1700 is worth avoiding that headache (and the costs of that headache) by ensuring you are satisfied.  I may have been a bit crass with my first response, but this refund is more than just a mere courtesy out of the goodness of their heart.  It is to their credit for being proactive about it, and not waiting for it to get nasty before trying to settle, like is so common these days.

  Agreed that paying the $1700 was the smart thing for the hospital to do. 

Think of it this way - even if there's a 1 in 10 shot that the OP would have sued, then even if the hospital thought there was a 100% chance they'd win the case, it would only take $17k in legal fees to make paying the $1700 a good choice.

Glitch99 said:   
raringvt said:   
Glitch99 said:   You likely have a valid malpractice claim, which - win or lose - would cost the hospital far more than $1700 to defend.  That $1700 is as much hush money as it is a refund.
This issue was heavily debated in the original thread.  After those responses & after doing some research on the issue of blood sample contamination, I don't think there's a chance in hell that the courts would possibly consider this malpractice. Sample contamination is extremely common & at the end of the day, I'm glad that they erred on the side of caution with my daughter's treatment.  The end result is that we were inconvenienced, my daughter received unnecessary antibiotics & the hospital stay cost a little money.  Nobody was hurt, and as a father of 3 (all born prematurely and all received care from this hospital after birth) I'm thankful that my community has such a strong children's hospital available to us.

  But it is something you could raise a stink over, and while you may or may not "win" it is a legit complaint.  $1700 is worth avoiding that headache (and the costs of that headache) by ensuring you are satisfied.  I may have been a bit crass with my first response, but this refund is more than just a mere courtesy out of the goodness of their heart.  It is to their credit for being proactive about it, and not waiting for it to get nasty before trying to settle, like is so common these days.

Fair point.  Though I do believe they did everything within protocol after doing some research (I didn't feel that way at first), had I raised a stink, I suppose it would be better for them to refund $1,700 rather than deal with me and have the situation escalate. For all I know, they looked my name up in their donor list and realized that I have given them way more than that as gifts and made the refund to keep me happy as a donor, not necessarily as a patient.  Whatever the reason, I'm satisfied that they did all of the right things for my daughter (other than trying to bill me for 2 ER visits).

daw4888 said:   I imagine the hospital still billed your insurance for the visit, and only wrote off your portion. If this is the case its highly likely that your insurance still thinks you were billed that amount, and that it still applies to your deductible.
  This is very likely, as long as you dont tell the insurance co anything else.

raringvt said:   Fair point.  Though I do believe they did everything within protocol after doing some research (I didn't feel that way at first), had I raised a stink, I suppose it would be better for them to refund $1,700 rather than deal with me and have the situation escalate. For all I know, they looked my name up in their donor list and realized that I have given them way more than that as gifts and made the refund to keep me happy as a donor, not necessarily as a patient.  Whatever the reason, I'm satisfied that they did all of the right things for my daughter (other than trying to bill me for 2 ER visits).
Now I have to ask... do you know if they have separate funds for donated money and hospital-generated money?  If they just have one general fund and the cause is important enough to you that you've donated way more than $1700, maybe you should have just asked for a donation receipt so you could make part of that money tax deductible?

raringvt said:    we are likely to make a charitable donation to the hospital (in addition to our normal annual gifts to them) to clear our conscience.
  With $10 tylenol pills and band aid charges, I'd see better use of that money tipping the nurses that cared for your kid.

Regardless of whether or not there was a valid malpractice claim (and I agree with raringvt having seen contaminated blood cultures often), I highly doubt a medical malpractice attorney would take on a case unless it had a reasonably good return on investment.  Here in California we have a cap on non-economic damages--I've heard even a 250k cap is enough to discourage a lot of attorneys even when there is a valid claim.

DTASFAB said:   raringvt said:   Fair point.  Though I do believe they did everything within protocol after doing some research (I didn't feel that way at first), had I raised a stink, I suppose it would be better for them to refund $1,700 rather than deal with me and have the situation escalate. For all I know, they looked my name up in their donor list and realized that I have given them way more than that as gifts and made the refund to keep me happy as a donor, not necessarily as a patient.  Whatever the reason, I'm satisfied that they did all of the right things for my daughter (other than trying to bill me for 2 ER visits).
Now I have to ask... do you know if they have separate funds for donated money and hospital-generated money?  If they just have one general fund and the cause is important enough to you that you've donated way more than $1700, maybe you should have just asked for a donation receipt so you could make part of that money tax deductible?



Many if not most hospitals will have a charitable foundation to receive donations which is separate from hospital operations.

Can we put the malpractice talk to rest please?

No deviation from standard of care means no malpractice.

No harm to patient means no malpractice.

The hospital was not afraid of getting sued. No lawyer in their right mind would take the case.

Hard to say if OP got money back as part of patient satisfaction or donor satisfaction or simply a recognition that the 2nd ED visit was unnecessary. But I am certain being a donor didn't hurt!

DrDubious said:   Can we put the malpractice talk to rest please?

No deviation from standard of care means no malpractice.

No harm to patient means no malpractice.

The hospital was not afraid of getting sued. No lawyer in their right mind would take the case.

Hard to say if OP got money back as part of patient satisfaction or donor satisfaction or simply a recognition that the 2nd ED visit was unnecessary. But I am certain being a donor didn't hurt!

  Ok sued for emotional distress ... a rose by any other name.

DrDubious said:   Can we put the malpractice talk to rest please?

No deviation from standard of care means no malpractice.

No harm to patient means no malpractice.

The hospital was not afraid of getting sued. No lawyer in their right mind would take the case.

Hard to say if OP got money back as part of patient satisfaction or donor satisfaction or simply a recognition that the 2nd ED visit was unnecessary. But I am certain being a donor didn't hurt!

  Yes, clearly OP raising a stink about contaminated labwork couldnt possibly cause the hospital any headaches or result in any bad publicity or any issues with insurance providers.  Obviously they gave him a $1700 refund, for which he never even asked, simply because they were feeling generous that day, and its purely coincidence that amount refunded is the same as what OP was charged for this completely unnecessary hospital stay...

Most likely is they refunded this money so he doesnt raise a stink with his insurance company, who will then question the entire bill not just the patient's share.  I'm guessing that 2 ER visits and a hospital stay of "several days" came with a total bill slightly higher than $1700, which an insurance company wont be happy to learn was completely unnecessary and due solely to the hospital's own lab error, especially future consequences should this prove to be a routine occurrence.

This is an example where words mean different things to different people.

"Contamination" to lay people means "major error."

"Blood culture contamination" to a physician is SOP, that's why we order TWO blood cultures every time we order ONE blood culture: contamination (especially by normal skin flora) is extremely common and we try not to make major life changing decisions based on false positives.

There's a lot that I don't know about this case and this is not my specialty and I didn't read the whole other thread, just skimmed it. But ideally, the conversation should have gone something like this. "We got the first of 2 blood culture results back and it is positive with a critical value and suggests your daughter needs antibiotics. However, your daughter really doesn't look that sick. She doesn't have a fever, she's eating, she's not delirious. I suggest we observe her carefully until the second culture confirms the first." Or, "However, your daughter doesn't really look that sick. I would normally not treat based on her presentation; however I understand that you may feel differently and we can discuss that." Or, "Your daughter doesn't look sick and we don't have the second culture back yet, but I would like to treat her anyway because the consequences could be very severe. What do you think?" Or some variation thereof.

Unless I am misunderstanding OP, the blood culture itself was not the major error. If there was a major error, it was the reaction to the first culture without proper clinical context.

There does appear to be 'harm' suffered by the child as unnecessary treatment is considered harmful. The devil is in the details regarding how the inherent uncertainty of inpatient medicine was conveyed, or not, to the family.

psychtobe said:   This is an example where words mean different things to different people.

"Contamination" to lay people means "major error."

"Blood culture contamination" to a physician is SOP, that's why we order TWO blood cultures every time we order ONE blood culture: contamination (especially by normal skin flora) is extremely common and we try not to make major life changing decisions based on false positives.

There's a lot that I don't know about this case and this is not my specialty and I didn't read the whole other thread, just skimmed it. But ideally, the conversation should have gone something like this. "We got the first of 2 blood culture results back and it is positive with a critical value and suggests your daughter needs antibiotics. However, your daughter really doesn't look that sick. She doesn't have a fever, she's eating, she's not delirious. I suggest we observe her carefully until the second culture confirms the first." Or, "However, your daughter doesn't really look that sick. I would normally not treat based on her presentation; however I understand that you may feel differently and we can discuss that." Or, "Your daughter doesn't look sick and we don't have the second culture back yet, but I would like to treat her anyway because the consequences could be very severe. What do you think?" Or some variation thereof.

Unless I am misunderstanding OP, the blood culture itself was not the major error. If there was a major error, it was the reaction to the first culture without proper clinical context.

There does appear to be 'harm' suffered by the child as unnecessary treatment is considered harmful. The devil is in the details regarding how the inherent uncertainty of inpatient medicine was conveyed, or not, to the family.
 

  You gave me red, yet we seem to be agreeing?  Whether it was the contamination itself, or the reaction to the initial results knowing that contamination is routine (by "botched" I just mean the result was wrong, even if done properly and within some kind of accepted rate of error), do you not think there are potential adverse consequences for the hospital should OP decide to raise a stink about it?  Or do you think the hospital spontaneously decided to refund the entire bill out of the goodness of their heart, with nothing to gain from quickly putting an end to OP's inquiry?  I appreciate your post from a practical, real-world perspective, but I'm confused.

Psych: Harm isn't getting a medication to no ill effect. Harm is getting a medication and then getting anaphylaxis or c dif. (But either way it's moot without deviation from standard of care as a cause of the harm, which is a required element for malpractice.)

Glitch: Insurance companies examine every single claim looking for an excuse to reject it. Patients are generally not going to be able to identify a problem with a claim that an insurer didn't already know about. I agree that with you that the hospital wanted to make this issue go away, but I think satisfaction of OP as "client" or donor is a way more likely rationale than fear of lawsuit or fear of insurer.

ETA: By the way, there was no lab error as you asserted.

glitch - No, I don't think the hospital would face significant consequences if the OP 'raised a stink.' A lot would depend on the details, as I said, and they are unknown. Our hospital does routinely refund small bills such as this one if it is just easier; not only because it is potentially cheaper or easier than a lawsuit (although it could be both) or because we are afraid of a lawsuit but also because we understand that sometimes misunderstandings happen and customer service/consumer relations is an important element of being part of a community.

Dr - the harm is modest but it is not zero. Being told you need a treatment and then receiving the treatment is considered a harm if it was not medically indicated. For example, if I tell you you are schizophrenic and prescribe clozapine and get weekly blood draws for four weeks and then tell you, Sorry, you were not schizophrenic, you actually are having seizures, you have suffered a damage even if you did not gain twenty pounds or develop agranulocytosis. You were subjected to a medication that was unnecessary and you had to have blood work four times, you were subjected to the emotional distress of thinking you had a life-altering illness, you had to worry about whether the medicine would work or whether you would have side effects, etc. So there is some 'harm.' I agree with you entirely, that without deviation from the standard of care, the fact that harm occurs does not mean there is malpractice. If someone is warned that lamotrigine can cause a rash, and then develops a rash, there is harm but not necessarily malpractice.

Psych, I think in your hypothetical the bigger concern is starting Clozaril as a first treatment when less risky choices are available. Although admittedly this is probably getting more than a little off topic.



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