I-Team

Billed For Medical Mistakes

TALLAHASSEE (CBS4) ― Most people believe that you shouldn't pay for something you don't get. If your restaurant meal is lousy, you ask the manager to take it off your bill. If the new TV doesn't work, you demand your money back. But the CBS4 I-Team has uncovered a practice in the medical profession which basically forces patients to pay for their medical care, even when medical professionals make mistakes, a practice some are calling wrong and unethical.

CBS4 I-Team investigative reporter Stephen Stock uncovered this business practice which has been an open secret in Florida's medical community for years, but is unknown to most people getting medical care.

Even though most patients don't pay the bill, virtually everyone pays for the practice through higher insurance premiums. Many times it is the insurance companies that foot much of the bill for surgeries that never happen or go wrong in the operating room.

The practice has so concerned legislators in other states, laws have been passed preventing it, but not in the Sunshine State. Medical and Insurance experts agree that in Florida, it's for doctors and medical professional to bill parents or insurers for their mistakes.

Rusty Juergens knows this financial nightmare from firsthand experience.

Last Thanksgiving, the 53 year-old father and church youth leader went in for routine knee surgery but never made it that far. A problem with the general anesthesia caused him to flat line, in effect, to die on the operating table.

Quick action by doctors brought Rusty back to life on the operating table. He had no ill effects after the problem he experienced in the hospital with the general anesthesia, and is now back at work in the Ocala hair salon he's owned for 8 years.

But, Rusty still has a bum knee. He never had the surgery he needed, but he did get something for his time in the hospital; Juergens got a hospital bill for his near-death experience.

"About a month after the surgery they started coming," Juergens said.

Not just one bill, Juergens said, but several bills from health providers responsible for the surgery he never had.

"When the bills started to come I waited then I called Blue Cross Blue Shield and I let them know," Juergens recalled. "I told them, you know, I just need to let you guys know that I went in for knee surgery and did not get knee surgery and you guys are paying for this."

Juergens was surprised by the insurance company's response.

"And they seemed to feel that that was okay," Juergens said, incredulous.

The CBS 4 I-Team discovered that these types of mistakes are more common than most know.

They are classified by researchers and those in the medical field as wrong-side, wrong site, wrong procedure, wrong patient adverse events, or WSPEs.

According to the Archives of Surgery, there have been 5940 WSPEs nationwide since 1991. In Florida, there have been 494 WSPEs since 1991. And since 2000, according to the Archives of Surgery, there have been an average of 75 WSPEs a year in Florida. According to the Centers for Medicare and Medicaid Services, in 1999 alone, medical errors cost patients 2.4 million extra hospital days...and 9 point 3 billion dollars in excess charges. This is the last year this type of data was available through the Centers.

"It is really happening out there," says Becky Cherney of Florida's Health Care Coalition.

The CBS4 I-Team discovered that 11 states currently have rules or procedures in place to prohibit doctors and hospitals from charging patients after these medical mistakes.

According to both the National Quality Forum a Washington DC based non-profit healthcare group, and Florida's Health Care Coalition, those 11 states are Delaware, Georgia, Illinois, Maine, Massachusetts, Minnesota, Oregon, Pennsylvania, South Carolina, Vermont, and Washington State.

Florida is not on the list.

Though adverse events must be reported under Florida law, there is no law prohibiting charging for WSPEs in the Sunshine State.

According to The National Quality Forum, patients in Florida have been billed even when a doctor cut off the wrong arm or leg.

Becky Cherney, President of Florida's Health Care Coalition, confirms that her data shows that as well.

"Isn't that incredible!?" Cherney asks.

"I mean if you take your car to the mechanic and you get it back and it's not fixed you take it back in but you don't pay again," Cherney told the CBS4 I-Team.

"And yet in hospitals when people do wrong site surgery they will charge to do the correct surgery and a number of other things that happen like that. People pay twice and that's absurd."

"Why do they do it? They do it because they can!" says Dr. Jay Wolfson.

Wolfson and colleague Dr. Paul Barach are leading researchers on this problem.

Dr. Barach, who used to work at the University of Miami's Miller School of Medicine, has dedicated his life to investigating these adverse surgical events. Barach is teaching in Europe right now, trying to learn first-hand how European countries handled these kind of medical mistakes.

In 2006, Dr. Barach, joined Dr. Samuel Seiden in publishing "Wrong-Side/Wrong-Site, Wrong-Procedure, and Wrong-Patient Adverse Events,"a research paper for the Archives of Surgery.

Doctors Barach and Seiden said their research uncovered data from 4 different sources that shows "WSPEs are more common than generally accepted or than is reported in the literature."

As an associate professor at the University of South Florida's School of Health, Dr. Wolfson currently serves on Florida's Patient Safety Coalition. So he knows from experience how often these events happen and how patients in Florida can pay whether the surgery is successful or not.

"There's no good reason for charging somebody for something that you broke,' Wolfson told the I-Team. "In fact you should go out of your way as soon as you found out that you broke it to let them know... fix it and give them a lollipop on their way out."

There is a movement to change this practice.

A group of large private insurers, led by Becky Cherney and her Florida Health Care Coalition, is moving to try to get doctors and hospitals to voluntarily STOP billing for their mistakes.

If not, Cherney says this group is contemplating further action such as going to state legislators to change the law.

At the University of Miami's Miller School of Medicine they're not waiting on lawmakers.

Professors at UM's Miller School of Medicine are, right now, specifically training future doctors to acknowledge they make mistakes...correct the mistakes... and professors are teaching future doctors to learn NOT charge the patient to fix those mistakes the doctors made.

Rusty Juergens is still trying to understand his near-death experience, two days in the hospital, $18 thousand in medical bills, and a knee which still has not been fixed.

"It's a bit of a rip off. It's rip off," Juergens says. "And the insurance company needs to look into this. Because it's costing each and every one of us."

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