High Hospital Charges Adding More Pain for San Diego Patients

SAN DIEGO --

People who need emergency medical care typically don't give the costs a second thought, until the health crisis ends and the hospital bill arrives in the mail.

"I'm not going to pay this until someone explains to me why it costs $7 dollars for one aspirin," says Steven Maddox.

He took that high priced pill while spending two nights at Scripps Memorial Hospital Encinitas. He'd gone to the Emergency Room after feeling some chest pains. Heart disease runs in his family, and it turned out he needed 3 stents. The procedure went well; the only complication was the bill.

"It said hospital miscellaneous $86,236.40. I thought, wow that's unbelievable."

He called the hospital and spoke to a billing clerk, who sent him an itemized version of the charges. But that didn't solve the problem, it only increased Maddox's frustration.

"The Lipitor was $27.88 for one pill! And I pay $1 a pill. One baby aspirin, $7 bucks, an adult blanket $146! I never saw that blanket!"

The three Boston Scientific stents he got run about $2,500 each, based on various published reports. That would be about $7500. He was charged $19,500 for all three.

"This is outrageous," he says.

The largest charges, two at $20,091 each, are still a mystery to him. They say "CDES Placement", but even his cardiologist didn't know what that was. By the way, his cardiologist charged him separately $3,000 for the procedure, and Maddox was also sent separate bills from his primary care physician and the Emergency Room.

Sometimes even doctors are surprised by the charges. Dr. Lokesh Tantuwaya is a neurosurgeon who ended up a patient last year. He says he really wasn't given an explanation of a bill stemming from a polo accident. Dr. Tantuwaya's horse fell down, and he went down with it. Knocked out for a few seconds, he decided to go to the Emergency Room at Scripps Memorial La Jolla as a precaution to get a cat scan. Although conscious, with no bleeding, and coherent, he was moved from the E.R. to the more costly Trauma room.

"I was sort of curious why they were moving me to the trauma room. They said it was protocol," he explains.

He stayed at the hospital a total of 3 hours.

"It didn't involve surgery; I didn't even get stitches placed."

His hospital bill came to $22,000.

Dr. Gary Fybel is Chief Executive of Scripps Memorial Hospital La Jolla. He defends the decision to treat Dr. Tantuwaya as a trauma.

"There are some very specific guidelines for trauma patients," he says. The guidelines come from the American College of Surgeons.

A 2003 audit of San Diego's trauma hospitals found more patients were being referred to trauma than in any other trauma system in the state. In come cases, hospitals were "over triaging" trauma patients 48 percent of the time.

Dr. Fybel points out that there are 40,000 paramedic runs in the county every year, and 25 percent end up as traumas. He says, "These are financed by patient charges." But he says the hospital does have a very liberal write off and finance policy for those who cannot afford to pay their bills.

Judy Dugan is research director for Consumer Watchdog. She says hospitals are "looking for opportunities to make up any losses that they may have elsewhere."

Her group advocates for consumers ripped off by medical providers. She says excessive chares are a major reason our medical costs are the highest per capita in the world.

"They're charging these immense amounts, the $10 pill, the $130 blankets, in order to get as much money as possible from insurers and from individuals."

She says patients like Stephen Maddox, who owes Scripps Memorial Encinitas $35,000, are at the mercy of the hospital because there is no limit to what individual patients can be charged. There is also no requirement that the hospital negotiate. Still, she says, patients should always try.

"Usually a hospital would rather get half the bill than none of the bill."