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Wednesday, December 29, 2010

First, Do No Harm. But If You DO Harm, Make Sure You Get Paid

We read an article a few days ago about psychiatric hospitals in New York suing indigent patients to recoup costs of treatment after those patients come into money.

In and of itself, we see no problem with this: We do not advocate withholding treatment from anyone because of an inability to pay; indeed, hospital budgets take into account a certain amount of charitable--i.e., unremunerated--services. At the same time, though, doctors and hospitals have a right to receive payment for services rendered. If people receive expensive medical services at no cost because they cannot pay, fine, but these same people have an ethical obligation to pay what they can and, if they receive some kind of financial windfall, they should repay the institution that served them in their time of need.

Here's the catch, though: The windfalls that the patients receive are often damages awards.

From lawsuits.

Against the psychiatric institutions themselves.

Thus, for example, a patient who successfully sued a hospital for negligent care that led to severe pain, suffering, and life-threatening infections, was subsequently sued by the hospital for $1.7 million dollars to reimburse for the costs of care.

We can't help but admire the sheer gall of these lawsuits, but we are troubled by the disturbing fact that judges tend to side with the healthcare providers. Think about the implication: If a hospital wants to recoup costs of indigent care, all it needs to do is to arrange an "accident." The bigger the damages award, the bigger the hospital's ultimate payday.


  1. Sounds like it came right out of Ankh-Morpork. Have you ever heard of this Discworld? They have this great national anthem; the national anthem of Ankh-Morpork. You can hear it sung with the by the BBC Scottish Symphony Orchestra. Please sing along as you listen I’ve placed the lyrics below.
    The lyrics of the anthem are as follows:
    "When dragons belch and hippos flee
    My thoughts, Ankh-Morpork, are of thee
    Let others boast of martial dash
    For we have boldly fought with cash
    We own all your helmets, we own all your shoes.
    We own all your generals - touch us and you'll lose.
    Morporkia! Morporkia!
    Morporkia owns the day!
    We can rule you wholesale
    Touch us and you'll pay.

    We bankrupt all invaders,
    We sell them souvenirs,
    We ner ner ner ner ner ner by the ears,
    Er ner ner ner ner ner ner ner ner ner,
    Ner ner ner ner ner ner, ner ner ner ner ner,
    Ner your gleaming swords, we mortgaged to the hilt.
    Morporkia! Morporkia!
    Ner ner ner ner ner ner ner ner ner ner ner ner ner ner ner ner
    We can rule you wholesale
    Credit where it's due."
    The final part of the anthem is usually sung much louder than the rest of the second verse, since the singers want to show they know the words...
    Incidentally, insurance was once attempted in Ankh Morpork, but it caused more trouble than it solved as everyone burnt their houses down.