THE LAW OF UNINTENDED CONSEQUENCES

Julius Caesar once quipped that all bad laws begin with good intentions. Today, many, if not most hospitals are the prisoners of commercially published criteria for admission to the hospital such as InterQual and others, which insurance companies, as well as governments use to determine payment for admissions. When Eric Duncan first presented to the ER, he had a low grade fever, dizziness, headache and abdominal pain. They should have asked about his travel history, especially in light of the Ebola outbreak in West Africa that was already underway, but they didn’t.

After examining him, and performing a CT scan of the abdomen and pelvis which was not diagnostic, they did what the screening criteria told them to do; gave him antibiotics and sent him home with the admonition to return if he got worse. Although we now know where the mistakes were made and, retrospectively, what should have been done, as I read it, absent the knowledge of his Liberian origin and/or Ebola contact(s), he simply would not have qualified for an inpatient admission under these “cookbook” guidelines. Moreover, with the decreased funding in healthcare, decreased reimbursements to physicians, and pure frustration with the insurance bureaucracy that has decreased the hospital beds as well as Primary Care Physicians, the US is ill prepared for any major medical event. Perhaps it’s time to worry more about the patient and our nation as a whole, and less about the bottom line.