:: to the teeth ::    thoughts on social justice, medicine, race, hope and beats

"Another world is not only possible, she is on her way.
On a quiet day, I can hear her breathing." :: Arundhati Roy ::

"The most common way people give up their power is by thinking they don't have any." :: Alice Walker ::
Sunday, September 25, 2005  

Miracle Baby - Only $30,000.00!

A few months ago I was approached by a volunteer health worker in my clinic. She timidly asked me if I could help her understand her University Hospital bill. We sat down and over the next half an hour she apprised me of her situation. I was stunned, and I've done alot of advocacy work as some of you might suspect.

This is a young woman who had a rare medical complication during her pregnancy. Antibody Kell. Act of God, nothing she did. It was picked up appropriately by routine prenatal care and the patient was referred to high risk pregnancy status in the Ob Gyn Dept. She was fortunate to have a wonderful attending doctor care for her. She received the highest level of care which included four blood transfusions and ultrasounds every other day for the remainder of her pregnancy. She reached full term and delivered a healthy (and now rambunctious 1 year old) little girl. This is a "miracle baby" who would have died if not for the advances in medical technology and the determined and rigorous application of these services to this fortunate family.

So what's the problem? Well, you might imagine that this was quite costly. This patient is a savvy woman and was aware of the potential cost so she asked her doctor and social workers about the bills. They all reassured her that the "high risk pregnancy fund" would cover the cost of the pregnancy. It is state money put aside to ensure that all women have the best opportunity to birth a healthy baby, regardless of income, ethnicity or nationality. She has a signed copy of that document. But somewhere in the aftermath of the miracle her family got caught in a hurricane flood of bureacracy. Her bills were denied by the high risk fund, she went into collections and started having troubles from collectors. The total doctors bill was roughly $8000 and the Hospital portion $22,000. This was before we were able to institute the fair price discount at the hospital so she couldn't qualify for 33% off. She was stuck with an inflated bill of $30,000 for a high risk pregnancy and delivery.

After 8 months of forging her way thru the paperwork and multiple financial aid appointments, she became so frustrated that she joined our coalition and wound up speaking her story in front of the Clinical Operations Board of the hospital. They were all duly appalled and referred her to the patient advocate. In the weeks following, they met, but he reassured her there was nothing the hospital could do, the bills were already in collections and from too long ago.

With further advocacy, she managed to get EMSA (Emergency Medicaid for Services for Aliens) to pay for the delivery portion of the bill dropping the bill by about $5000. The hospital also decided to carve away about $1500.00 of her prenatal bills that were "inappropriate" charges. So she was now down to $23,500.


First we met with the financial aid director whom i had talked with the day before. She was super nice and agreed to shave off about $5000 more. (she also agreed to advertise my clinic to uninsured patients since UNMH is full!) But more importantly, she agreed to really look into why the bill wasn't paid for by the "high risk pregnancy fund." this was and still is the big mystery. noone there knew the answer. We then moved over to the doctor side of the hallway. The first worker we met was hostile but we were lucky in that the bill was already in collections, so "she couldn't help us." sometimes that's a real blessing. :> The next lady we met was awesome. She had a miracle baby herself, a granddaughter born too early, so she understood the CONTEXT of this person's life. My patient was no longer a number or a problem, but a person worthy of helping. She promised with a smile to look into the doctor portion of the bill and help us understand why it wasn't paid by high risk. Incidentally, I had talked with the attending doctor the week before and she remembered this patient well because the medical condition is 1/1,000,000. She was shocked and frustrated that the patient still had a bill and felt like her hands were tied as she had tried all appropriate avenues to assist the patient from the inside.

So who knows what will happen next, but something special happened for this patient and me that morning. She told me afterwards how different it was to enter that space with an advocate, a doctor, how it changed the way she was seen, felt, treated and possibly the future of her families life.

This is a hard working poor family. They love their "miracle child" and her older sister. It's a case where all the safety-net systems failed, all the doctor's efforts to rectify failed, the board of the hospital failed, and perhaps we too will fail to find justice in this case. But not before this case is sitting on the governor's desk with a big long story in the daily paper.

To imagine a whole world of lies circling around this young families lives like a tornado with hands reaching out to grab their money, voices yelling at them to pay their way, frustration paving their path to a future of debt to a public hospital.

Another world is possible.

It is time for our society to invest in the values we spout all over the public eye - Family Values. I am thankful to this patient for helping me learn my world, for having the courage to speak up for her life and the future of her family. I am thankful that I am in a position, politically, to walk that path with her. And i'm thankful that her munchkin 1 yo cute child comes along on all the walks.



posted by andru | 9/25/2005 07:29:00 PM | |


dr. andru & dr. taneja,
what is the best way an undergrad interested in studying for public health prepare? courses? experiences? what grad schools have good programs?


# posted by Anonymous Anonymous : 10/07/2005 2:51 PM  

Anj, I'll email you this too but I *totally* hope you're not too busy to miss this tomorrow... it's in your hood!!!


- cliu

# posted by Blogger Connie : 10/08/2005 6:55 PM  

my advice - best way to prepare for studying public health at a U.S. university is to go to a foreign university of public health first. or to participate for a few years in a social justice campaign.

in general public health in the united states is not about social justice or human rights. it is about disease control, emergency preparedness and managed care. stats as well as recent experience will show you that we suck as a nation at all of these endeavors.

i applaud the few humanists still in public health for their valient efforts but overall most departments are corrupt organs of their various state and federal governments unable to offer much in the way of constructive health policy advice to communities struggling with environmental or racial injustices.

# posted by Blogger andru : 10/13/2005 10:13 PM  

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