I want to share a story I’ve seen at work. A lady in her early fifties had come over from Indonesia to see her family. She did not have travel insurance, because she had COPD (a type of chronic lung disease) and it would have been expensive. She brought along some of her own oxygen (which she only needed for emergencies) and her medications. Unfortunately, while she was in the UK she began to deteriorate – people with COPD commonly get lung infections, or ‘exacerbations’. These commonly can be treated in the community but more severe episodes require a short hospital stay with nebulisers, steroids and antibiotics to recover. Very severe exacerbations are life-threatening, especially in the frail, but in general most get better within a few days.
Anyway – the story. She attended hospital acutely short of breath and was seen in A&E, given initial treatment, and flagged up as a foreign national who was not entitled to free healthcare. In the morning she was informed of this, with the help of a translator, along with the recommended medical plan to stay in hospital for 2-3 days to recover with the help of nebulisers etc. She refused to stay despite the best efforts of the medical registrar on-call to convince her to, on account that she did not want to (or could not afford to – it is unclear) pay for treatment, and left to be with her family.
Two days later she came back in, substantially more unwell. She was started on treatment again, with IV antibiotics this time, and for a while she looked better. She went up to the ward around lunchtime.
Two hours later, I hang up on the on-call neurology consultant as my bleep screams out a crash call. She is peri-arrest, unresponsive, with one of the worst blood gas results I have ever seen. ITU are involved, she is intubated, ventilated and moved to the unit.
1) I knew perfectly well that if she wasn’t able to pay for treatment on AMU, she sure as hell wasn’t going to be able to pay for treatment on ITU (costs being well above £1000 a day). Did I hesitate for a moment, contemplating this, before she was intubated? Of course not – a person was dying in front of me. What kind of person would I be if I let her die because of money? I’d be a monster. Did anyone else hesitate? No. Would you?
2) Ultimately, and somewhat ironically, this lady is going to cost the NHS significantly more as a direct result of telling her she had to pay for treatment. Realistically, the NHS is not going to recoup its costs from this woman, if she survives. If it hadn’t been attempted, in all likelihood she would have been in AMU for 2-3 days and that would have been that. The thing that really struck me about this case in the feeling of culpability, that the very fact that money was asked for precipitated the chain of events leading to her being intubated on intensive care.
3) All of this trouble could have been avoided if she had simply paid for travel insurance.
Image credit – Taylor Ann Dixon ©2014
It’s difficult to see exactly what should have been done here. Clearly, the NHS cannot give out free treatment to all foreign nationals – it would be a disaster – but there needs to be some scope for emergency treatment. Equally, no human being deserving of the name is going to stand by and let someone die because their bank balance isn’t big enough. As with much of medicine, this story sits in shades of grey…what would you do, policy-wise, to try to prevent this happening again?