Hospital 'Observation' Status Prompts Federal Class Action Suit
He signed a notice indicating he was a hospital inpatient and was moved to a hospital floor. But he never actually was technically admitted as an inpatient, leaving him responsible for paying Part B co-insurance for outpatient claims and $5,685 for skilled nursing facility care he received after he left the hospital, according to the lawsuit.
Another patient, the late Nettie Jean Sapp, 77, had a history of breast cancer, Parkinson's disease and rheumatoid arthritis, according to the complaint. Just before she was taken to the hospital, she experienced profound weight loss, weakness, and episodes of memory loss.
When she fell in her home, she was taken to Scott and White Hospital. There, during a five-day stay, she received a head CT, X-ray of the lumbar spine, an EKG, a bilateral carotid ultrasound, and a brain MRI, the lawsuit says. She was diagnosed with a urinary tract infection and received oral and intravenous antibiotics.
But "because she was not formally admitted to the hospital and therefore did not satisfy the three-day rule, her subsequent care in a skilled nursing facility, from April 26, 2010 through June 24, 2010, was not covered," the lawsuit says. She subsequently moved to an assisted living facility, where she died, because she could not afford the cost of the nursing facility.
Bills in Congress would correct part of the problem by allowing the time a patient spends in observation to be counted as inpatient care to satisfy the three-day rule. They were introduced by Sen. John Kerry, D-Mass and Rep. Joe Courtney, D-CT.
"Given the tenor of the times," Deford acknowledges, "those bills are unlikely to go anywhere."
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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