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Treatment Denied

Staple remover“I’d like to have someone take out these staples,” said the well-dressed woman who came to the registration window.
“OK,” said the registration clerk, “we’ll get you registered and we’ll get you right back to a room.”
“Perhaps you didn’t understand,” the woman stated as her voice went up a few decibels, “I want someone to take these staples out now and I’m not going to register to have it done.”

The registration desk is on the other side of the wall from the fast track nurse’s station. There was a lull in the action, so I was leaning against the wall talking with a couple of nurses when we heard the woman raise her voice. Everyone stopped talking, looked at each other, and furrowed their brows. One of the nurses went up to the registration area to perform some reconnaissance while pretending to use the copy machine.
She came back with a sour look on her face.

“It’s Rhonda Jones. Her family owns several restaurants in the area. They’ve got a lot of money and they like trying to push people around.”

The registration clerk was already getting flustered. “I’ll have to call my supervisor. Just a minute, ma’am.”
“Is Dr. Koop down here today? Maybe you can just call Dr. Koop instead.”
Dr. Koop was the head of the medical staff and well-known in the community. Very high-profile doc, but he was a cardiologist and didn’t work in the emergency department.

“Just a moment, ma’am. Ummm … Dr. Koop isn’t on call tonight.”

Now to put things in perspective, I don’t have any problems doing minor things to help patients. There’s a policy that all patients seen in the emergency department must have a chart made. On one hand, medicine is a business. I get that. On the other hand, morally, I have a hard time justifying a several hundred dollar charge to a patient for doing something that takes two minutes. I’ve gone out to the waiting room or into the triage room and pulled sutures, adjusted a splint that was too tight, and checked people’s blood pressure for them – without registering them to be seen. To me, it’s just the right thing to do and I think it improves the hospital’s reputation with the patients.

By this time the woman had raised her voice to the point that people in the waiting room stopped talking to see what was happening.

“You call Dr. Koop NOW and tell him that Rhonda Jones is here,” she said firmly.

I walked out to the registration desk.

“Is there a problem?”
“I need to have these staples removed.”
“Why are you raising your voice with the registration clerk?”
“She wants me to register so that I get another hospital bill and I’m not registering to have it done.”
“Unfortunately, the hospital policy is that anyone receiving treatment must be registered to be seen.”
“Then you need to call Dr. Koop. He’ll come and remove the staples.”
“Again, we don’t call doctors when they’re not on call, and I’ve never seen a doctor come in from home to remove staples, so even if we did call Dr. Koop, I doubt that he’d come to the hospital tonight.”
“He’s a family friend of ours. He’d come.”
“Have you tried calling him?”
[Awkward pause. . . .]  Uh oh.
“What is your NAME, doctor?”

And so it went from this woman attacking the registration clerk to her attacking me, then calling the administrator on call and telling her I was being rude, then saying the CEO of the hospital would be getting a call in the morning.

In the end, the woman made a fool of herself and she stomped out of the hospital without getting her staples removed.

For once I didn’t have a moral dilemma about it, either.


  1. Did she follow through and call the CEO?

    My CEO’s phone number is quite literally in the book: it is surprising to me how often people threaten to call and then do not when he is so readily available.

  2. Forget the bill aspect.

    As we all know, the minute anyone medically lays hands on a patient, all the legal caveats apply.
    Consent, duty to care, diligence, standard of care, etc. etc.
    Anyone who lays hands on a patient who refuses to register within a hospital setting should be ceremonially beaten in front of staff, and then made to stand in the corner with a dunce cap on for three days, and fed on hospital food.

    If Risk Management (or whatever a given facility’s administrative and legal eagles call themselves) wouldn’t be inordinately willing to administer the beating, and gladly bring their own weapons, you aren’t practicing anywhere in North America.

    Mrs. Jones is suing the hospital, because her staples were removed in the cootie pit that dwells outside the registration window, is now claiming that the site got infected, and her lawyers are claiming every symptom in the book and demanding great fortunes in damages. The ED practice group has been ordered to deliver one head on a platter by noon, or the lawyers are going in there with sticks and beat them all to within an inch of their lives, and the CEO has volunteered to hold the offender’s arms behind his back when the axe falls.”

    The legal term for a patient inside the hospital that isn’t registered is “non-existent”, BTW.

    (“Sorry, we seem to have no record of a patient visit by Mrs. Jones at any point on the date in question.“)

    It’s childish, but if one treats people like they’re invisible until they register, it tends to solve a lot of problems. If they still refuse to play, security initially, and the PD if necessary, can be a great help in arresting criminal trespassers at that point. If an arrest takes place, we generally follow up with a restraining order, making them someone else’s problem in perpetuity.

    (Oh, wait, wasn’t there a crazy woman who had to be escorted out by the police on that day?”
    I defer to counsel, but at that point, the security camera record and police reports tend to make further threats of legal action miraculously go away.
    Trial juries seem to regard such behavior in a negative light so the cases never get filed.)

    I suspect it’s also very difficult, and costly, to explain one’s behavior to Daddy Warbucks after the fact.

    The only real pity is that simply smacking them in the nose with a rolled up newspaper at the outset is neither legal nor ethical.
    It’s certainly justice.

    Bonus point: If they never registered, they don’t get a Patient Satisfaction Survey in the mail either!

  3. By the way, even if the patient registers usually there isn’t a bill sent for suture removal. I’ve had enough ED sutures on myself and kids… None of the hospitals charged a follow-up visit for removal. I’ve only gotten initial bills.
    Like surgery, we see the doc for follow-up but they include the cost in the original payments.
    Maybe it’s because of insurance but I can’t imagine sutures wouldn’t have removal built in too

    • If I recall the CPT book correctly, suture removal cannot be charged for if sutures are removed in the same facility that placed them. So if you go back to the ER that stitched you to have them removed, they cannot bill for the procedure of suture removal. If you went to your primary physician for removal of sutures placed in the ER, the primary could bill for the removal procedure. The ER could instead bill a “wound check” visit, with a regular E/M level of service code. But most don’t unless the wound is really gnarly (e.g., infected) and requires additional treatment at that visit, like a script for abx.

  4. What an ignorant, low class woman! Hopefully she will have an attitude adjustment at some point in her life.

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