TX - pregnant wife unresponsive on life support, husband hopes to fulfill her wishes

BBM

Hello, nrdbs4,
"...patient died within 24 hours of a hospital admission..."
triggering notice to ME seems pretty straightforward.
As a longtime (former) home office employee in another field (investments), I'm always interested in how 'legal' req'mts work in policy & actual practice in other industries.

Are you speaking from experience in US?

The original question to which I responded referenced Texas law, so the answer to that would be yes.
Do you recall if hosp had explicit written policy.

Of course. Anything mandated by state law would be reflected by explicit written hospital policy.

Mainly, who within hosp was responsible -- floor nurse, supervising nurse, chief of nursing? Attending doc, admitting doc, ER doc? Admin-type personnel? (Obviously I may not have med terms right here)

Doctors declared death and time of death. Notice to ME was usually made by Nursing Supervisor.

How was notice to ME made? Phone? Fax? email?

By phone.

How was notice to ME documented, esp if by phone.
Where recorded? Nursing notes? Doctor-entries in pt chart?
If ME's response not written (fax, email), how documented at your/hosp end? Where recorded?

I was a staff RN and shift charge nurse. I was not a unit manager or nursing supervisor, so I can't speak to their documentation. We (nurses) would be notified that it was a ME case or not (affected post mortem care; for example, a patient going for autopsy left with all tubes in place-ET tubes, central lines, etc., whereas a patient going to a funeral home had everything disconnected, was cleaned up, etc.), that kind of thing. I would always document my post mortem actions, so by reading my notes, it would be obvious if my patient was an ME case. As a staff RN, I never spoke to the ME so can't speak to how they responded.

I imagine any facility, med or non-med, may have technical reqmts slip between the cracks, esp if employees are overworked and underpaid.

Speaking only for my working experience (ICU in a county hospital, ICU in a large metropolitan hospital) and not for every medical facility in Texas, absolutely NOT. Never would a requirement to call the ME in the case of a death occurring within 24 hours of admission "slip through the cracks." NEVER. The facilities in which I worked took state law pretty seriously. ICUs are well acquainted with death and the laws which pertain to that. Roles were well defined with respect to this kind of thing. If you are asking if medical facilities do not comply with the mandate to report a death 24 hours after admission, all I can say is that in the facilities where I have worked, that would never be the case. I personally have never worked in a facility where the staff was "overworked and underpaid" to the point where they would neglect to follow state mandates, either willfully or by neglect due to distraction. In fact, I'm happy to say that every unit in which I have worked has always been run completely "by the book" in every way; that ethic was something I always perceived to have come from the top levels of management all the way down to the staff nurse actually providing the care. In my experience, anyone who didn't have pretty high standards for themselves didn't last very long in our environment. Even if one didn't have a strong work ethic, most professionals in this kind of environment are acutely aware that the potential for litigation provides the wise professional with plenty of incentive to cross all one's T's and dot every i. Other nurses may have different experiences.

Back to the Munoz situation specifically, I wonder -
Was she declared BD within 24 hr of admission?
Did she meet another TX parameter for notice to ME?

As to the Munoz case, I have no knowledge whatsoever of the timeline of anything related to her condition or care.
 
nrdbs4

Thank you ever so much for your informative response, re how hosp notice to ME works in practice.
Med personnel here, esp on Munoz thread, have provided a wealth of info to people like me -
in the dark on medical issues and hosp practices.

If or when I am ever a pt in a hospital, I can only hope to be on your floor or a floor w nursing staff like you
or the hosp where you work.

Thnaks again. :seeya:
 
Although this link was pub. Wed 02/05, and we discussed hosp billing, off & on, I did not see this article posted.
http://www.kvue.com/news/state/243854971.html

"Erick Muñoz said he is completely in the dark when it comes to billing. He told News 8 that two medical bills came to his home from John Peter Smith Hospital early on, but there haven’t been any since.
"To force Eric Muñoz into bankruptcy over an act that was clearly inappropriate and wrong... " said his lawyer, Heather King.....
...JPS is publicly funded and county-owned. So is it a bill that may be covered by the citizens of Tarrant County? ....
The cost ... still unknown. Health care economist Dr. Adam Powell estimates the daily cost of intensive care unit treatment is $5,000.
...Marlise ...declared brain-dead two days later. This raises the question whether Erick Muñoz is responsible for a two-day bill estimated at $10,000.
Or will he get billed for Marlise's entire 62-day stay ...?
A projected bill for a 62-day hospital stay at a considerably larger $310,000. This does not take into account that Marlise Muñoz had health insurance."

Anyone else seen updates on this since Wed? Thx in adv.
 
Although this link was pub. Wed 02/05, and we discussed hosp billing, off & on, I did not see this article posted.
http://www.kvue.com/news/state/243854971.html

"Erick Muñoz said he is completely in the dark when it comes to billing. He told News 8 that two medical bills came to his home from John Peter Smith Hospital early on, but there haven’t been any since.
"To force Eric Muñoz into bankruptcy over an act that was clearly inappropriate and wrong... " said his lawyer, Heather King.....
...JPS is publicly funded and county-owned. So is it a bill that may be covered by the citizens of Tarrant County? ....
The cost ... still unknown. Health care economist Dr. Adam Powell estimates the daily cost of intensive care unit treatment is $5,000.
...Marlise ...declared brain-dead two days later. This raises the question whether Erick Muñoz is responsible for a two-day bill estimated at $10,000.
Or will he get billed for Marlise's entire 62-day stay ...?
A projected bill for a 62-day hospital stay at a considerably larger $310,000. This does not take into account that Marlise Muñoz had health insurance."

Anyone else seen updates on this since Wed? Thx in adv.

He may get automatically generated bills, but I would hope after the judges ruling the hospital won't expect him to pay and will write it off.
 
He may get automatically generated bills, but I would hope after the judges ruling the hospital won't expect him to pay and will write it off.

Beginners
Agreed, seems like hosp would not expect payment from Mr. M.
Seems like hosp officials would turn off the 'billing faucet' to prevent the auto-gen bills, as a matter of community relations, imo.
Submitting bills to Mr. M in this situation would rub salt into the wound, imo.

A neighbor commented about various billing statements she rcvd after a hosp stay.
Hosp, lab, xray, CAT scan, and doctors reading & interpreting them.
I wonder if JPS hosp will pay bills from other health care service providers to Ms M. I hope so.

JM2cts and I maybe wrong. :seeya:
 
Beginners
Agreed, seems like hosp would not expect payment from Mr. M.
Seems like hosp officials would turn off the 'billing faucet' to prevent the auto-gen bills, as a matter of community relations, imo.
Submitting bills to Mr. M in this situation would rub salt into the wound, imo.

A neighbor commented about various billing statements she rcvd after a hosp stay.
Hosp, lab, xray, CAT scan, and doctors reading & interpreting them.
I wonder if JPS hosp will pay bills from other health care service providers to Ms M. I hope so.

JM2cts and I maybe wrong. :seeya:

Yes, I would hope that those get covered also. There may have to be some back and forth with attorneys to get it done. But Mr. Munoz will probably still receive billing statements from ancillary providers that are separate from the hospital that will need to be forwarded on to CHO or their attorneys.
 
I think you missed the part of my post where I said, personally, I'm fine with the family being able to pay for it or not. lol But there are a LOT of other people who would disagree. They will argue that it's unfair for a person to be able to pay for long-term medical intervention, but that a person who can't afford it is SOL. Especially when there's a baby involved. Is the life of the baby whose family can't afford it less worthy of saving then the life of a baby whose family has the money? etc. etc. That would be a ch*tstorm extraordinaire, imo.

Yeah, count me as one of those people that think that would be chit! If we are dealing with life and death, socioeconomic status should not come into play. So a rich person's fetus would be more valued than a poor person's? F that! Last time I checked, the "life, liberty and pursuit of happiness" applied to everyone. It doesn't have a clause that says, "only if you can afford it."
 
Yeah, count me as one of those people that think that would be chit! If we are dealing with life and death, socioeconomic status should not come into play. So a rich person's fetus would be more valued than a poor person's? F that! Last time I checked, the "life, liberty and pursuit of happiness" applied to everyone. It doesn't have a clause that says, "only if you can afford it."

Everyone can decide to continue on with a pregnancy like this. Poor or rich should pay for it whether it takes just one day to come up with the money or it takes 50 yrs to come up with the money. If you do not expect the poor to pay then who should pay?
 
No disrespect, but bringing up a situation that hasn't occurred, no examples have been given of it ever occurring and is the exact opposite of the situation in this thread, is not applicable.
 
For anyone who may be interested, Iver Benson was born on Feb. 8. at 28 weeks gestation. He weighed 2 lb. 13 oz. His dad, Dylan Benson, knows that difficulties lie ahead and that there is no guarantee that Iver will survive. Robyn Benson was taken off medical intervention procedures following the C-section.

http://abcnews.go.com/blogs/health/2014/02/11/meet-the-baby-born-to-a-mom-on-life-support/

This is a follow up to a previous post.
Mods, please snip if too far OT. Thanks.
 
The John Peter Smith hospital is still determining who should pay for the 62 day stay of Marlise Munoz. At this point it seems that the hospital is taking no responsibility for its decisions and is "working" with the Munoz insurance company to pay the bills. And then, my bet, is they start chasing Erick Munoz.

http://thescoopblog.dallasnews.com/...l-pay-for-brain-dead-womans-62-day-stay.html/

Oh yes, here we go! I will be absolutely stunned if the insurance company pays one red cent in this case. Of course, when they deny the claims, I've no doubt the hospital will go after Mr. Munoz. And what will it cost him to fight that fight?

IMO, this hospital needs new attorneys and better PR staff. They will be forced to play their game in the public eye if they decide to go forward. One poor judgement call after another.
 
Oh yes, here we go! I will be absolutely stunned if the insurance company pays one red cent in this case. Of course, when they deny the claims, I've no doubt the hospital will go after Mr. Munoz. And what will it cost him to fight that fight?

IMO, this hospital needs new attorneys and better PR staff. They will be forced to play their game in the public eye if they decide to go forward. One poor judgement call after another.

Yes. Hospital v Insurance Company. According to the khou article ff JPS will not go after Erick Munoz directly, but have made no official statement about what their position will be should the insurance companies agents refuse to cover the JPS claims. (http://www.khou.com/news/texas-news...to-husband-of-brain-dead-woman-250401621.html) I agree with you that the insurance provider will not be forthcoming with money to cover the JPSH bills and that JPSH has made a series of poor decisions.

IIRC, a fund was established by other EMTs and Firefighters to help Mr. Munoz with potential medical bills. I doubt if it reached the six figures this bill would undoubtedly reach.

I always thought that someone would be billed for a service they have requested not for one which they refused. Mr. Munoz did not request service after his wife was declared brain dead as his suit against JPSH proved. In effect, the administrators of JPSH made the decision to attempt to bring an unviable fetus to term by ventilating and medicating a dead woman's body. They took any decision out of the hands of the family. Therefore, I think the administrators of the hospital are the ones who should take individual responsibility for the decisions they made and bear the burden of the expense. Not the hospital, which would mean charging the taxpayers in the county for the admin's decision.

IMO, the following people, and possibly more, should state what their responsibility was in the decision making process and in condoning the decision to follow that course. They should explain why they did not immediately make financial arrangements with Insurance providers or the lawmakers in the state capital to underwrite the cost of their actions.

First and foremost: the JPS Legal Counsel and Vice President of Communications & Community Affairs.

Then: the JPSH President and CEO; COO; the Senior Vice President Quality; the CMO; the Vice President, Finance; the Chief Technology Officer; the Senior Vice President, Chief Nursing Officer; the Chief Risk Officer; the Vice President, Patient Care Services; the Vice President, Operations; the entire Board of Managers.

When questioned early on about where the money would come from, the VP CCA refused to be specific. ' “When appropriate, the finance department will pursue its customary process for identifying payers and reimbursement,” hospital spokeswoman J.R. Labbe said by email.' (http://america.aljazeera.com/articl...uaozcasehighlightstexaspoliticaltensions.html)

So I guess JPSH has decided that the time is right. Labbe quickly sent off a note to correct the tweet from WFAA's John Panicker that Erick Munoz would not be billed. (http://thescoopblog.dallasnews.com/...l-pay-for-brain-dead-womans-62-day-stay.html/)
 
Yes. Hospital v Insurance Company. According to the khou article ff JPS will not go after Erick Munoz directly, but have made no official statement about what their position will be should the insurance companies agents refuse to cover the JPS claims. (http://www.khou.com/news/texas-news...to-husband-of-brain-dead-woman-250401621.html) I agree with you that the insurance provider will not be forthcoming with money to cover the JPSH bills and that JPSH has made a series of poor decisions.

IIRC, a fund was established by other EMTs and Firefighters to help Mr. Munoz with potential medical bills. I doubt if it reached the six figures this bill would undoubtedly reach.

I always thought that someone would be billed for a service they have requested not for one which they refused. Mr. Munoz did not request service after his wife was declared brain dead as his suit against JPSH proved. In effect, the administrators of JPSH made the decision to attempt to bring an unviable fetus to term by ventilating and medicating a dead woman's body. They took any decision out of the hands of the family. Therefore, I think the administrators of the hospital are the ones who should take individual responsibility for the decisions they made and bear the burden of the expense. Not the hospital, which would mean charging the taxpayers in the county for the admin's decision.

IMO, the following people, and possibly more, should state what their responsibility was in the decision making process and in condoning the decision to follow that course. They should explain why they did not immediately make financial arrangements with Insurance providers or the lawmakers in the state capital to underwrite the cost of their actions.

First and foremost: Neal Adams, JPS Legal Counsel and Jill "J.R." Labbe
Vice President, Communications & Community Affairs.

Then:

1. Robert Early, President and CEO
2. Bill Whitman, COO
3. Aubrie G. Augustus, Senior Vice President Quality
4. Gary Floyd, MD, Executive Vice President, CMO
5. Doris Hunt, Vice President, Finance
6. David Mendenhall, Chief Technology Officer
7. Wanda Peebles, RN, Senior Vice President, Chief Nursing Officer
8. Scott Rule, Chief Risk Officer
9. Trudy Sanders, Vice President, Patient Care Services
10. Kathleen Whelan, Vice President, Operations
11. Trent Petty, Chair, Board of Managers
12. Ralph Waldo Emerson, Jr., Board Vice Chairman
13. Dorothy DeBose , BoM
14. Scott W. Fisher, BoM
15. Rex Hyer, MD, BoM
16. Roy Lowry, DO, BoM
17. Steve McCollum, BoM
18. D.T. Nguyen, BoM
19. Charles Powell, BoM
20. Karen Van Wagner, PhD, BoM
21. Charles Webber, MD, BoM

When questioned early on about where the money would come from, Labbe refused to be specific. ' “When appropriate, the finance department will pursue its customary process for identifying payers and reimbursement,” hospital spokeswoman J.R. Labbe said by email.' (http://america.aljazeera.com/articl...uaozcasehighlightstexaspoliticaltensions.html)

So I guess JPSH has decided that the time is right. Labbe quickly sent off a note to correct the tweet from WFAA's John Panicker that Erick Munoz would not be billed. (http://thescoopblog.dallasnews.com/...l-pay-for-brain-dead-womans-62-day-stay.html/)

This is a very powerful post. Thank you.
 
Thanks Gitana. When I re-read it, I was worried that I'd violated the rules. I got way too carried away. Sorry mods.
 
Thanks Gitana. When I re-read it, I was worried that I'd violated the rules. I got way too carried away. Sorry mods.

We shall see who leads this battle - should they foolishly decide to wage it. IMO, the hospital needs to tread very carefully here. It would be beneficial to them to drop it. Now.
 

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