Dispute over hospital stay

What is the name of your state? Arizona. I took my 9yr old daughter into the ER on Sunday night. She had had pneumonia the previous month. ER did a chest x-ray, gave her breathing treatments, and gave her 1 dose of antibiotic IV. I have no medical insurance and made sure to let eveyone within earshot understand we needed to get in and out as soon as possible. They wanted to keep her over night because her lungs didn't sound great. I agreed. Over the next 2 days they treated her aggressively for asthma. The antibiotic was not continued. There was no improvement in her condition. Finally on Wednesday they did another chest x-ray and said she had pneumonia. They started her on oral antibiotics Wed afternoon. She was released Thursday morn. I believe her stay was extended by three days unnecessarily. If they had continued to administer the antibiotic that was started in the ER, I believe we could have left Monday. Should I pay for those three days? My daughter has never been dependant on inhalers. She only has problems when she picks up a respiratory bug. She doesn't start wheezing from dust or allergies.

[JETX]

"Should I pay for those three days?"
*** Your question is not relevant. The only issue is that you WILL be billed for those days unless you can get the hospital to waive them. And if you are billed, you are obligated to pay (as agreed when you signed the forms at the hospital).

Also, you can't use the 'hindsight' diagnosis to justify your assumption that the stay "was extended by three days unnecessarily". You have provided NO evidence to indicate that she had pneumonia when you took her in, only that it had progressed to that point the next day. It is possible that the IV antibiotic was the appropriate treatment for the condition at the time she was first diagnosed and that it progressed into pneumonia. Absent an opinion by a QUALIFIED physician of an initial misdiagnosis, your assumption is just that..... an assumption.

I beg you pardon. It was my understanding when you have a patient present with the symptoms my daughter did, and a recent history of pneumonia, you get the chest x-ray, and you treat accordingly. Apparently the ER doc felt she needed antibiotic therapy. I don't know of any "condition" that calls for the administration of a single dose of antibiotic. You either say she needs antibiotic and give the full course, or you say she doesn't need antibiotic. She didn't develop pneumonia the next day. She presented a very slight improvement, leveled off, and then started to decline. It was almost a full 2 days later. Just long enough for her body to process that single dose of antibiotic and the bugs to regain the ground they lost. The staff up in the pediatric unit was not even aware she had been given an antibiotic down in the ER untill I asked them about it. I didn't ask earlier because I was practically brain dead from lack of sleep. So no, I don't think it was hindsight. I believe the ER doc started treating her for pneumonia but this bit of information was not relayed up to the floor.

[ellencee]

jabusch
JETX has answered the billing question. I am answering to hopefully answer some of your questions regarding the treatment your daughter received.

Without reviewing the actual records and having facts on which to comment, I am going to respond based on what I infer from your description of the events and my experience as a Pediatric nurse, which was my first clinical specialty and my first field of practice.

There are IV antibiotics that are given as a 'loading' dose and there are anitibiotics that are given as a preventative measure. I have seen children with asthma receive the latter (preventative antibiotic) given in the ER for 1 dose, usually a substantial dosage of a long-acting broad spectrum antibiotic, and followed by no further antibiotic administration. Therefore, I can not say this definitely indicates an improper action by the ER physician. If her chest x-rays and her bloodwork do not indicate the presence of an active infection, then it was (more likely than not) a proper intervention.

From your description, I infer that your daughter has 'reactive airway disease' and not chronic asthma. Either type of asthma has a two-way impairment of the airways. Air can not enter the respiratory system sufficiently and air can not leave the respiratory system sufficiently. Where air goes, moisture goes; where air stays, moisture stays. Therefore, when a cold brings on an episode of reactive asthma, the moisture in the respiratory system is trapped in the bronchial airways and the lungs along with the impeded air exchange.

In the respiratory system (including the lungs), there are certain groups of bacteria that are always present. In certain conditions when the air and the moisture are trapped in the respiratory system, the bacteria grow to an abnormally high presence and become an 'infection'. Viruses, such as a cold virus, can also settle into the lungs and cause a viral infection. When the infection settles into a part of the lung, usually the lower part, and obstructs the air exchange in that area of the lung, it is pneumonia. (Pneumonia can be diagnosed without a chest x-ray; however, your daughter did receive a chest x-ray in the ER and apparently no pneumonia was present in her lungs.)

Opening the airways to allow proper exchange of air and moisture was an appropriate course of treatment. If it took from Sunday to Wednesday to sufficiently open her airways, then it would have taken that long even with antibiotics.

A cold (which is a virus, not an infection) would not respond to antibiotics but would bring about the onset of asthma in person's with reactive airway disease and could lead to a viral pneumonia with or without an associated bacterial pneumonia. It could take several days for the pneumonia to develop and it is not a 'given' that the pneumonia would develop.

If you had stated that on Wednesday, your daughter began to receive IV anitibiotics, I would be more inclined to say that the antibiotics should have been continued without interruption. Because she was essentially given a prescription and sent home on Wednesday, I am inclined to believe that any presence of pneumonia was minimal and expected to clear quickly now that her airways were sufficiently open.

Please check with the hospital's social workers' department and ask about any funding resources that may be available to pay all or part of your daughter's hospital stay. As your daughter does have a type of asthma, there may be a specific program that assists in meeting the financial burdens of medical care for children with asthma.

If you have any x-ray reports or bloodwork reports that you would like to post, I will be glad to review the results and comment further.

Best wishes,
EC

EC, thank you for your response. The first x-ray report states extensive peribronchial thickening. Second one says LLL atelectasis versus infiltrate. The blood work wasn't done until the first afternoon. Wbc's were elevated. I don't know how much. Everything else was normal. I actually have no problem paying the bill as long as it's fair. It was one of the peds nurses who told me she didn't think my daughter developed pneumonia after being admitted. She said the report she "listened" to of the first x-ray "showed an area of consolidation". She said that could either be pneumonia or atelectasis. Thanks for your assistance. You're a gem!

[ellencee]

jabusch
If the radiologist who 'read' the film could not differentiate between atelectasis (failure to inflate) and lobular pneumonia (LLL=left lower lobe), then whichever process was present was only minimal and required correlation with other signs and symptoms in order to be properly diagnosed.

An elevated white count without the differential values available to consider is not enough information for me to say if it should have been used to determine or rule out the presence of pneumonia.

Did your daughter present to the ER with an elevated temperature above 102 degrees (F) orally? Had her temperature been elevated to or above 102 before you took her to the ER?

I don't know if that information would really make a difference. I'm just trying to think this through. It wouldn't do me any good to ask about a cough, not in the presence of asthma, or following a bout of pneumonia.

I'm still of the opinion that the treatment was (more likely than not) proper and based on the need for resolving the asthma effects. I base that on the oral antibiotics being prescribed and her being dismissed from the hospital on the same day.

Please keep your daughter under adult supervision for a while. She is at risk of having another episode of asthma and possibly the attack would be more severe. Keep her inhalers and, or epinephrine injection within easy reach, too.

Thanks for the compliment and for calling me a 'gem'. This time, maybe I am a sparkling gem; other times, my flaws show and sometimes I shatter!

EC

Thanks EC, we are going to negotiate the bill in the am. Want all the info we can get to bring the total down. Figure worst case is we can negotiate for the rate an ins co would pay. You have been MOST helpful! Baby girl is on advair at present to get her through the change of weather bugs. Again, THANKS