CT Scan First, then Take Two and Call Me in the AM

I started this long post curious if the economic logic of the private, not-for-profit Dallas Presbyterian Hospital where Thomas Duncan was treated led to his demise, a point raised by Amy Goodman in Democracy Now! But the issue of the scandalous treatment obviously goes beyond that.

Reportage on Ebola in Africa has been lacking, to put it inoffensively. At its worst, what I’ve seen (admittedly not much) could have come out of a zombie show or movie and slides into racist narratives of African savagery. Ebola seems but a new twist on the wars that ravaged the region, and both are presented without history, context, nuance: No Why has been asked, let alone answered. But the reportage that I’ve caught (I’ve not studied this; capture has been incidental and cursory and entirely via the Web) has only now begun to investigate Whys that Americans can put forth.

The BBC Tuesday had a decent comparison of the MSF procedure and the so-far opaque but increasingly alarming lack of coherent protocols practiced at the Dallas hospital. And the recent accounts by unnamed nurses at the Dallas hospital describing the lazy and frankly appalling procedures only points to some other questions.

Let’s start with money. Duncan walks into Dallas’ Texas Health Presbyterian (also called Presbyterian Hospital of Dallas), a private, not-for-profit hospital whose parent system is Texas Health Resources. US News & World Report rated it highly. It’s not a cheap hospital. In Duncan’s case, according to two reports, from the Christian Post and the Dallas News, the cost of his terminal care (starting with this second trip to the emergency, where he arrived via ambulance), is likely to be around 500,000 USD (The Christian Post). That sum, the Dallas News points out, will likely never be recovered from his family and will be used to justify the hospital’s not-for-profit status; as well, it will be “‘covered by the margin on commercial insurance,’ said Scott Schoenvogel, CEO of Compass Professional Health Services in Dallas” (Dallas News). [Cost is “recovered” by Dallas hospitals via a “practice known as ‘cost shifting.’ Insured patients have a hidden surcharge in their bills, which winds up raising the cost of annual health insurance premiums for workers and their employers” (Dallas News).]

But who paid for the initial CT scan and the lengthy if utterly meaningless evaluation the first time around? It seems that Duncan was given a CT scan of the head, which could have been of the brain (I don’t have the data) and might have cost as much as 2,925 USD (New Choice Health)—or a lot less, 210 USD. The other costs, including the evaluation, even the acetaminophen (Tylenol brand, it seems), would have been added to the charge.

Then he was sent home, with no effort to monitor him at home, or to see if he was contagious.

Put another way, the tests that were performed seemed more to satisfy a wholly ineffectual but costly ritual than to address a known problem and one that had that day, or the day before, been broadcast to hospitals as a serious threat by the CDC.

But the Texas Health hospitals, like any hospital system in the US, it seems, was under no legal obligation to abide by the CDC guidelines. I find that incredible, in that I can’t quite believe it. But then I remind myself that the US still operates under a laissez-faire medical system that seeks to maximize patient cost at the expense of social health.