"Live Free Or Die." -The State of NH's Motto
Last time I received my chemotherapy I had a severe reaction that caused respiratory distress requiring oxygen, tachycardia with a heart rate greater than 150, a temperature of 102.8, and a blood pressure of 50/30, normal is 120/80.
All these symptom point to septic shock, a life threatening infection.
The standard front line treatment for this are anti-biotics and fluids. If blood pressure does not respond to the increased volume with the fluids, medications called pressors may be necessary.
So why, if I presented at the Emergency Department circling the toilet, ready to code at any second and the treatment is obvious and readily available, did I wait for 4 hours to receive any intervention of fluids or antibiotics?
FOUR HOURS!! Were they waiting for me to die before they intervened?
It turns out, they may have been.
Rumors of "Project LEAN," whereby hospitals are trying everything to cut costs due our Nations' dire financial situation, which has cut their reimbursement rates, have doing rounds.
In NH to continue to provide care with the current state budget, hospital's need to provide care in a less expensive manner to everybody. By doing this, the insured who they are paid to treat, can carry those on Medicaid who they are not adequately reimbursed to treat.
This is rationing of treatment.
If you feared it, it is here. I have all ready experienced it, and yes, the budget constraints caused by America's financial crisis could hurt or kill you too. No one is safe, but before it was just a rumor.
Now, it is fact.
NH's Senate passed the budget last week. Below you will read the cause and implication of this budget straight from The President's of Dartmouth Medical's Hospital and Clinic and a plea to our state representatives from The Board of Trustees at Dartmouth Hitchcock Medical Center:
As many of you learned in media reports this morning, members of Dartmouth-Hitchcock's Boards of Trustees sent a letter to each member of the New Hampshire State Senate, expressing their concerns about the impacts of the state budget that was passed by the Senate on June 1. We have provided below a copy of the letter for you.
This letter reflects the seriousness of the situation that could be imposed on us, and it outlined some possible consequences of the state budget. As it currently stands, this would cost Dartmouth-Hitchcock an additional $40 million next year, bringing our total underfunded Medicaid reimbursement to $100 million.
As we told you in OurView and at Town Hall meetings, we've been actively involved in discussions in Concord about alternatives to the budget, and are deeply disappointed that our suggestions have fallen on deaf ears.
No organization, regardless of its size, can sustain such a shortfall. If this budget is enacted, we would have no choice but to consider significant changes in our operations, across the entire Dartmouth-Hitchcock system.
Our Trustees, in their letter, pointed to some examples of areas that might possibly be impacted, but it is too early to talk about specific programmatic changes that may have to be made.
What is clear is that our organizational mission and vision will guide us as we face this challenge. These are extraordinary times, requiring us to think about extraordinary steps to secure our position for the people of New Hampshire and Vermont.
Dartmouth-Hitchcock is fighting to sustain the high-value health care for which we are known and we will keep you advised of further developments. Thanks to the commitment of all of you who work so hard to make Dartmouth-Hitchcock what it is, we remain confident in our ability to deliver on our mission. Nancy & Jim
May 26, 2011
The Honorable Peter Bragdon New Hampshire State Senate The State House 41 Green Street Concord, NH 03301
Dear Honorable Peter Bragdon: We are writing to you in our capacity as Trustees of Dartmouth-Hitchcock to express our concerns about state budget decisions that will have serious negative consequences for our institution and the people of New Hampshire.
We share a common bond with you a deep commitment to the health and well-being of children, families, seniors, and communities across our state. The mission of Dartmouth-Hitchcock and the 8,700 dedicated people who work here is to ensure each person in our state receives the best care, in the right place, at the right time, every time.
We are stewards entrusted with a fiduciary responsibility to our organization and its mission. As trustees, we understand and appreciate the difficult decisions facing the Senate Finance Committee and the full Senate. We, too, must make tough decisions to meet the financial challenges facing our institution. That is why we are obligated to share our concerns with you.
In our Fiscal Year 2010, Dartmouth-Hitchcock served over 43,000 individual NH Medicaid patients throughout the state with more than 2,000 admissions to DHMC and 154,176 office visits. The cost of caring for these Medicaid patients totaled $88 million. NH Medicaid's regular payments for these services were just $28 million, leaving Dartmouth-Hitchcock with a $60 million shortfall.
Under the proposed budget, eliminating Medicaid uncompensated care payments will push this shortfall to nearly $100 million a year for Dartmouth-Hitchcock. The impact of these losses will be staggering.
Our de-facto role as New Hampshire's safety net hospital will be compromised. All New Hampshire's citizens -- not just Medicaid patients -- depend upon Dartmouth-Hitchcock for specialized care that is unavailable elsewhere in the state: comprehensive, pediatric specialty care; and the only Level 1 Trauma and Pediatric Trauma Units in northern New England.
New Hampshire's rural geography means that large areas of the state are served by small rural hospitals which, by federal designation, must limit the services they provide. These small hospitals rely on DHMC to provide a comprehensive range of services and a level of care that they cannot offer. These services will be jeopardized if the huge cuts considered in Concord are enacted.
Here are negative impacts to Dartmouth-Hitchcock if our projected $40 million Uncompensated Care Payment is eliminated:
* Our ability to sustain under-funded services such as the neonatal intensive care unit at the Children's Hospital at Dartmouth-Hitchcock and our air transport program (DHART), serving the entire region, will be harmed.
* We will be challenged to maintain our credit rating, which may limit our ability to access credit and could create debt compliance issues that would drive up the annual cost of currently outstanding debt.
* We will have no choice but to consider a reduction-in-force. Well-paying professional jobs will be lost, stifling New Hampshire's attempts to rebound in a difficult economy.
* We believe that attempting to shift these Medicaid losses to private payors is undesirable because it will ultimately increase insurance premiums for employers and employees. New Hampshire's businesses and municipalities are already strained by health insurance expenses; exacerbating the problem leaves less money for job growth. Cost shifting is indeed a hidden tax.
* Necessary capital improvements will be deferred. Forgoing these improvements may impact access to and quality of care for New Hampshire's citizens. Because of the need for DHMC's level of services, our institution is frequently at "triage level", which means patients who need care immediately must wait sometimes many days -- until a bed or operating suite becomes available. This will occur more frequently.
We urge the Senate to reconsider cuts to Medicaid Uncompensated Care Payments to hospitals. While we recognize that you must develop a balanced biennial budget, we ask that you to fully fund the Uncompensated Care Program for FY 2012, and then look to an improving economy for budget adjustments in FY 2013.
Respectfully, Dartmouth Board of Trustees********What happened on the day of my ER visit was, essentially, predicted, and the finger is pointed directly out our financial crisis.However, the hospital's possible "solutions" will not work. The Project Lean initiative they attempted to bestow upon me backfired. When they eventually prescribed fluids they ran two litres in simultaneously for a total of 6 litres of fluid.Had I been treated immediately, I probably would have only needed three.Forcing so many fluids so fast when I was all ready experiencing respiratory issues sent me into further distress, which required intervention and supervision in the special care unit by putting me at risk for "flash pulmonary edema" and respiratory arrest.The indwelling catheter they refused to place, instead using a straight catheter to collect a urine sample, eventually did have to be placed for help getting the added fluids out of my body, especially my lungs, with such a low blood pressure.Then I had two catheter placements instead of one, putting me at further risk for a hospital acquired infection and costing them twice as much.They did not save any money by resisting standard treatment on me. They probably doubled their costs.Surprisingly, however, they didn't offer the State Senate any suggestions or options either.Here are a few for our state:Allow computer gambling where ever gambling is all ready occurring in our state, such as the dog track. This has been previously proposed to raise funds. If people have money to gamble, it's money they could use to support the hospital's and our sick.Provide Legislative protection from frivolous litigation for Physician's and Use the "The Physician's Liability Fund," which hospital's and physician's pay into for protection against malpractice lawsuits, but is now sitting dormant, as a one-time measure to offset the medicaid reimbursement difference. Previously, this was proposed to use the physician's fund solely to balance the budget, not to save the integrity of our hospitals, and was stopped due to a lawsuit from Health Care Agencies. This is a reasonable compromise for both parties, because trust me, there will be more lawsuits if poor practices continue. Even after 5 years with cancer, if I died after waiting in the ER for four hours without treatment it would have been a wrongful death suit worthy of a pay-off.If this isn't possible for government and healthcare to work together (and it's probably not), invest the 110 million in a secure income fund or bonds and use the interest. Nobody is screaming about the interest. That DOES belong to the state.Use money raised from the cigarette tax to assist with medicaid reimbursement. NH proposed earlier this year to remove the cigarette tax to increase tourism. IF this money is so disposable, it shouldn't be difficult to put it where it belongs: towards Health and Human Services.An even less popular proposal, raise the cigarette tax. Ten cents is not making or breaking smokers and it is not the deciding factor as to whether or not they will cross our borders for vacation. VT taxes $0.85 per pack, and they are avoiding this health care crisis.Here is another crazy idea: stop the prohibition on marijuana. Reefer Madness was propaganda. What does the government have against a plant thats worst side effects are hunger, paranoia, and altered consciousness.These side effects are less worrisome than the effects of alcohol. No one has ever died from a marijuana overdose. It could be regulated much like alcohol, sold in specific location to adults over 21 or with a prescription.This would be a two-fer, it would raise funds and alleviate the costs of arresting non-violent smokers. and Keene, NH residents proved, in essence, the legality of marijauna in NH by hosting "smoke-ins" last year in the center of town for weeks on end. No arrests were ever made of the 100+ people who gathered to smoke in piece.I would certainly rather we institute these changes to our way of life before budget cuts lead to any other person suffering the way I have. It is not too late. The House has yet to approve the budget and the governor is watching over it closely. Please tell them we all understand budget cuts hurt, but they can not allow them to kill.