Needy Patients Are Waiting

Jersey Lord was as frantic as a politician can be.  “Lapius, anything, I promise you anything.  You have to get my mother-in-law into the convalescent center.”

“No trouble at all Jersey.  Simple as making a phone call,” Lapius started to un-cradle the receiver.

“Who are you calling?” Lord asked suspiciously.

“The convalescent center for a bed.”

“You don’t understand, Lapius.  Despite outward appearances, despite the political nature of my job, I am not a wealthy man.  I could show you my income tax returns --,” Lapius forestalled him with a wave of his hand.

“Not that, Jersey.  Income tax returns as a means test have recently lost their credibility.  However, I’ll take you at your word.  You are not a wealthy man.  What has that got to do with putting your mother-in-law into a nursing home?”

“Well, Simon, you know that if she goes into a hospital for three days first Medicare will pay for several weeks in the nursing home.  Otherwise my mother-in-law will have to pay.”

“Don’t tell me that your mother-in-law wants to show me her tax returns as well.”

“Lapius, you are being facetious about a serious matter.  She has become a burden.  We must admit her someplace where she can receive better care than we can give her at home.”

“If that’s the only reason, Jersey, Medicare won’t pay even if she goes to a hospital first.  They only pay for extended care if the patient’s condition warrants it, not just because she required domiciliary care.  But in any case we don’t have any beds in the hospital.”

“That’s outrageous.  How can a community plan so poorly?”

“The community hasn’t planned poorly.”

“Then why don’t some of you doctors go out and build a hospital.  Lord knows we need the beds.”

“Well Jersey Lord didn’t know it when he voted the law that demanded hospitals had to show a certificate of need before adding beds.”

“We were misled in the legislature.  The fellows from Washington came down and showed that there were a surplus of hospital beds in the nation.”

“Sure,” Lapius said, “But the problem is how to move the surplus beds to our community where there is obviously a shortage, not only of beds, but of stretchers on which to place people who have to sleep in the hall.  The trouble, in this area, is that the old system of supply and demand has broken down.  In the old days if there was a need for some beds, enterprising people would build the appropriate accommodation.  We could even an overnight hospital stay for frail people too weak to make the trip for x-rays.  The way things are now we have to hospitalize them for a week to get procedures done that would take a day if the appropriate facility existed.  We have to use hospital beds for the chronically ill before they can be moved to a nursing home where, like your mother-in-law, they should be moved in the first place.

The hospital has been trying for years to get a radiotherapy department, but because there is one about thirty miles away, you people in Trenton decide that it would be a duplication of services.”

“Well, thirty miles isn’t too far to go for x-ray therapy, Simon.  That’s not unreasonable.”

“It’s too far to go if there is a gasoline shortage or you have a broken hip.  Look Jersey, I would help your mother-in-law if I could.  I would even let her stay here for a few days if I could get the appropriate certification from the state that my domicile can be turned into a hospital for the weekend.  But the fact is that your mother-in-law is bound in red tape, trussed to the point of immobility.”

“But she needs help.”

“Of course, she does,” Lapius sympathized, “but no one takes the individual into account when they make laws.  They take the community into account.  Not the local community, but the county, state and federal community.  No doubt the statistics from Washington are correct, that there are enough hospital beds in the country.  But they might be in Kansas.  Then your mother-in-law could be placed there.  But of course her doctor couldn’t take care of her.  The hospital would have to assign another doctor.”

“So you can’t do anything to help me, Lapius.”

“I’d like to, Jersey, but you tied my hands when you assented to the CON.”

“CON?”

“Certificate of Need. You thought it was a great idea.”

“The system sounded logical when they explained it in the state capitol.  But it doesn’t seem to work.”

“Why did it sound logical in the state capitol?” Lapius wanted to know.

“Because the government felt that since it had subsidized the construction of hospitals with Hill-Burton funds, it didn’t want the hospitals it built to meet competition from the private sector.  There might be hospitals with empty beds, and that would be too expensive for the community.”

“But they didn’t figure how costly to a life and limb it would be if a community was short of hospital beds.  For a country that has given its surpluses away, to deprive itself of proper health facilities for its citizens because it fears surplus in hospital capacity borders on cruel indifference.  Illness can’t be fine-tuned so that there is a perfect fit between the supply and demand.  If there has to be waste, it should be in terms of money, not the sick.”

“Well,” Lord said, “I’ll have to think of something.” 

“I’m sure you will, Jersey,” Lapius said soothingly.  Lord brightened suddenly.

“I’ve got it Lapius, I’ll send her on a cruise.”

“On a cruise?”       

“Yes.  Lapius, can you get me the address of the hospital ship HOPE?”