Teen Who Died of Covid-19 Was Denied Treatment | Hacker News Reader

Teen Who Died of Covid-19 Was Denied Treatment

gizmodo.com

44 pointsmaxwell42 comments

For non-US readers: Somebody made an incorrect decision to take him to an urgent care office, which requires immediate insurance or payment, rather than a hospital, which has to admit you if you're acutely ill, then bills you later.

You're supposed to use urgent care for minor things like an earache or prescription refill.

The "insurance hack" in the US is that since hospitals must accept you if you're critically ill, you don't need any insurance to get admitted and treated initially. Also the initial paperwork is less burdensome if you're critical.

The reason for that is because hospitals were dumping comatose patients on lawns at other hospitals to reduce their costs. Hey, capitalism.

I went to one of those urgent care places once. I had food poisoning, but I'd never had it before and thought I was dying.

Here's what happened:

- I had to sit and fill out paperwork for 20 minutes before being admitted

- They put an IV in me and gave me something "for nausea"

- The nausea medication had an extreme anxiety-inducing effect (and I was of course already anxious), which they didn't explain until it was happening. I physically couldn't relax my muscles because of the meds. It was nightmarish. And only after I mentioned this did they add some Benadryl in there to offset it.

- The doctor had no idea what could be wrong (again, I realized later it was food poisoning; they couldn't figure this out) but offered me an MRI (??). Luckily, even in my extremely anxious state (which had been increased since I arrived), I knew that was a ridiculous course of action.

- They sent me home. I received a bill in the mail for $3,500, of which my insurance paid about half.

I will never, ever go to one of those again. You shouldn't either unless you're bleeding out on the floor.

Here's my anecdote: I twisted my ankle while running a 5K and thought I broke something. I hobbled in, signed some paperwork, and waited a few minutes because my injury wasn't life-threatening. My leg was examined by a nurse practitioner and it was determined that it was most likely sprained. Told to rest, take Tylenol for pain, and return if things got worse and they would do an x-ray. My ankle healed and I was fine.

Bill after insurance? $200, which isn't bad here.

This is what an urgent care is for in the US: non-life threatening care that isn't an emergency but can't wait until your next visit with your primary care physician. If you think you're dying, go to the ER.

Here's my anecdote: I've lived in three different countries in my life and, despite seeing a doctor when needed, I have never even so much as seen a medical bill in any of them, let alone had to pay one.

> You shouldn't either unless you're bleeding out on the floor.

That's the thing though, they aren't for life threatening emergencies.

> For non-US readers: Somebody made an incorrect decision to take him to an urgent care office, which requires immediate insurance or payment

Is this something that all US readers would know? What about people who have never been to such a place?

> You're supposed to use urgent care for minor things like an earache or prescription refill.

Surely urgency comes in degrees and someone with the symptoms of COVID-19 is surely in more urgent need than someone who has an earache.

I realize that the name is just what it is called; I'm not really arguing for a change of name, after all it's not my country, but it does seem quite plausible that someone might go to such a place under the (mis)apprehension that urgent needs would be attended to and payment be dealt with afterward.

I doubt most people here realize the emergency room can't refuse a real emergency due to lack of insurance but I almost guarantee fear of large hospital bills is the reason the urgent care was the first stop, it's the cheapest place to get care without needing an appointment. So unfortunately I don't think it was confusion about what an urgent care offers (it's a pretty well known service for the above reason) as much of fear of cost over going straight to the emergency room.

>Is this something that all US readers would know?

They should. "Urgent Care" "Immediate Care" etc are oftenin office parks next to lawyers/realtors/dentists. They are where you go when you do not have a primary care provider, or can't be seen by your primary care provider, and are sick. You take your kids to them for physicals for their school sport or when you have a bad cough and don't want to/can't wait a week for your doctor to squeeze you in.

You walk in, sit in a waiting room with 10-20 sick strangers and wait sometimes for hours to be seen, then meet one of umpteen doctors working that you've probably never seen before and will never see again that looks at you for maybe a minute and writes a prescription or tells you to go to your doctor.

They are 100% for acute, non-life threatening illnesses and injury.

In my part of the US they've changed the names of a lot of these places from "Urgent Care" to "Walk-in Clinic", which is really what they are: a doctors office you can go to without an appointment for pressing but non-life threatening issues. For point of reference the Emergency Room is where an ambulance would take you if you called for one. If you are in a similar type of life threatening situation and you choose not to call an ambulance but to drive yourself most Americans know they need to go to the ER.

You actually need to be really careful with Urgent Care clinics, because some work out an arrangement where they are an "extension" of the hospital's ER.

What does this mean? It means they get to inflate what they charge you for certain procedures because they're "an ER", but somehow aren't bound by all the other regulations hospitals are.

In short: be bloody paranoid. The only pattern I've noticed in Urgent Care centers using this weird billing hack is they tend to offer some of the more advanced imaging services in-house.

it definitely has the potential to be misleading, but it makes sense in the overall hierarchy of urgency. in increasing order of urgency: general practitioners office, urgent care, emergency room. I believe each tier is also more expensive (although idk about urgent care vs GP's office). if you have insurance/money, you really want to avoid going to the emergency room when you don't need it because it's very expensive. the catch is, if you're broke, you go to the ER for everything because they can't turn you away and the debt doesn't really matter.

I've been treated by urgent care for an anaphylactic reaction and a major cut on the hand. They definitely can and will treat and triage something seemingly as mild as flu like symptoms, if you have insurance.

Given the situation, urgent care clinics should be allowed to bill Medicaid or a similar program for treating uninsured people with covid19 symptoms. Sometimes, they are the only general medical care available.

The question I have is if hospitals are unprepared for the surge of covid19 cases, how much can most urgent care clinics do, since they are by design much leaner operations. The whole point of them is low cost, low overhead emergency care.

> urgent care clinics should be allowed to bill Medicaid or a similar program

I believe they can already, at least if it's patients who qualify for Medicaid (if you're proposing expanding Medicaid to temporarily cover all uninsured, then it's true that isn't the case). But it's up to the urgent-care clinics whether they want to take Medicaid patients or not. Around me, some do and some don't. The ones that don't, refuse it because they aren't willing to perform services at the Medicaid rates (Medicaid has fixed reimbursement schedules, set by each state).

> if you're proposing expanding Medicaid to temporarily cover all uninsured, then it's true that isn't the case

Yes, specifically for COVID19 cases.

This is just it. In a 2 Trillion dollar bill, there's no payment for those with Covid directly? It's inhumane but also irrational. During a pandemic, you need those with no insurance or scary-high co-pay to get tested and get help, otherwise, they become vectors for spread. It's literally probably cheaper to pay for their coverage.

It's weird that they were fighting for a few billion here and there in this bill for special projects, I thought some would be saying: "no bailouts without everyone covered for covid" or something like that.

But to see American leaders and press basically spend all day fighting each other on cable news, just another day of bickering, contrasted to almost every other nation where it's mostly muted and they talk about things they are doing, what you should do for Covid, updates etc.. It's really embarrassing.

> I've been treated by urgent care for an anaphylactic reaction and a major cut on the hand.

Good to know. How major was the cut?

Deep enough to require stitching - from a kitchen knife

> The "insurance hack" in the US is that since hospitals must accept you if you're critically ill

Work hard, save hard, get unlucky, go to hospital, go bankrupt. Don’t just lose your health, also lose savings and dignity.

There is no way the US should be considered a first world economy when “freedom” means freedom to become destitute if you have the bad fortune to be a low income earner.

I'm surprised the 2 trillion dollar bill did nothing to cover uninsured people.

Yep, if his family hadn't made that mistake he might be alive and they'd simply be bankrupt instead

Ya whoever took them there made a mistake but that just illuminates the fact the system affords this type of power to this person where any layperson is in position to make a life or death decision of someone elses life. What kind of sick fuck that works at these urgent care centers can look at someone that sick and send them away? Rotten to the core...

Urgent care is also great for somewhat more serious things like minor lacerations—they can put in stitches. If you go to an emergency room (especially right now) you might be waiting for many hours.

The copay is lower at urgent care too.

"You're supposed to use urgent care for minor things like an earache or prescription refill."

And the cold, flu, et all other non-critical conditions. The problem is, O Care or no care, many people still go to the ER for immediate care. That is why hospitals are in jeopardy of being overwhelmed in the US. That, the under-staffing of caregivers in said facilities and the leegions of drug seekers(addicts) that abuse the system daily. The core problems of For-Profit Healthcare in the US have never been addressed, nor will they be in any "Aid" packages, so long as the few "Groups" are making billions in "not-socialism" Guv paybacks & handouts. Crisis times are going to be hugely profitable for the administrations, regardless of the toll it takes on the practitioners.

They let a 17 year old die because they didn't have enough money?

In many other countries this would be criminally culpable but in the US they aren't even going to release the name of the "urgent care" clinic. Immoral.

And don't even come to me with "well its complicated." No it isn't at all complicated. The kid didn't have money so they turned him out on the street, without even a safety evaluation, and he died before he could get care elsewhere.

There's nothing complicated about that, you're pretending it is complicated to avoid the moral and ethical implications of what actually happened.

People pretending like no medical triage, because he lacked means, is perfectly fine and that it was actually the [medically unqualified] victim's fault for not self-diagnosing well enough to go to the correct facility are apologists of the worst kind. It defies both common sense and basic decency.

They didn't turn him out on the street: they sent him to the emergency room and he died en-route. Urgent care clinics are not hospitals, they don't even like writing prescriptions for anything other than antibiotics. At best they could have called him an ambulance.

This. People need to understand that these clinics are not equipped to deal with this stuff, they do not have ventilators and equipment like that. They are not hospitals, some are no bigger than a dentist office. Some clinics like this may only have one doctor on staff with just Nurses and PAs seeing patients. If this kid was in that bad of shape they probably couldn't have helped him at this facility.

Doesn't matter. If they made the professional judgement call he needed more than they could offer, someone should have been calling 911 in order to get a meat wagon on the way. If he was bad enough gone to have to head to an ER, th he Urgent Care should have at a minimum hit him with prednisone and a nebulizer treatment to get his airways open. Most also have Epi-Pens on site if they were really worried about his chances of making it to the hospital alive.

You don't get to cherry-pick patients because it's inconvenient. Shit happens, and you're the Doc/NP. Get out the prescription pad, write a scrip or call in to the nearest pharmacy to expedite, and have office staff or whoever drove him in pick it up.

Welcome to professional culpability. Now if what they said was, we won't see you because you can't pay; go to the ER, some naming and shaming is in order.

If someone's at risk of dying on the way to the hospital making a CVS run is not the right call.

More meant as a mitigation to "The ambulance will be here in 15 minutes. Go next door, get this, and bring it back so I can keep him alive until then." You are by no means helpless as a medical practitioner with modern pharmaceuticals minutes away most anywhere.

Not "Stop at CVS on your way there." Once a medical practitioner sees you are in need of more intensive care the onus is on them to ensure they do what they can to get you there alive.

I'm fairly secure in my assertion of these courses of action. Even bounced it off an RN to make sure; so I'm not just pulling it out of my ass here.

The kid would likely have died waiting for an ambulance in Los Angeles. Especially up in the Antelope Valley. If he had transportation, expeditiously sending him on his way was the right call.

But when they did, they must have realized he was in a life-threatening situation. Covid-19 doesn't make you go from a minor cough to death in a few hours.

That's why they wouldn't have been able to do anything for him. They don't have the means to intubate him. They only handle minor physical injuries, x-rays, vaccines, and things treatable by routine prescriptions.

But they could have done something for him! They could have called an ambulance for him to ensure that he was rushed into a proper healthcare facility! That they didn't and just turned him away because he lacked proper insurance is sick and insane.

That's would have happened in any country with universal healthcare. If I go to a local healthcare facility and they think I'm having symptoms of a heart attack they just don't shrug their shoulders. They would call an ambulance and get me to a real hospital asap.

Look at the video https://www.youtube.com/watch?v=NkhnAF7E5xw All they did was refer him to another hospital. Sickening.

They referred him to another hospital. That's what I would call "turn him out on the street".

Likely, the boy had no idea how bad his condition was. Had he been examined by the physicians it would have been found out and he would have been rushed to a real hospital.

>They let a 17 year old die because they didn't have enough money?

They referred the parents to a facility that could actually provide treatmeint. Urgent Care /= ER/A&E. They are for non-life threatening illnesses.

For some sort of comparison it would be like taking your car that has smoke pouring from underneath the hood to the place on the corner that only sells car parts and has very limited diagnostic tools to try and help you figure out what the issue is.

> Mayor Parris explained in his YouTube video that the 17-year-old is believed to have had no underlying conditions that may have contributed to his death.

I guess Gizmodo missed this key update to the story. Odd, the update was published some 2-1/2 days prior to publication of the Gizmodo article.

https://www.kcra.com/article/california-minor-dies-due-to-co...

"Urgent Care" facilities are not emergency rooms or hospitals, they do not have the equipment necessary, few have very little medical tech in them at all with the most advanced things being contactless thermometers and maybe an x-ray. They are little more than offices with private examination rooms.

They are 100% for acute, non-life threatening illnesses and injury.

Whoever is claiming he was denied for insurance is likely confusing what was actually said. Even if they'd had a suitcase full of unmarked non-sequential 20$ bills they'd likely have been able to do anything for him besides refer them to an emergency room/call an ambulance.

This article is garbage, it is 100% trying to get clicks and isn't even remotely actual journalism.

> This article is garbage, it is 100% trying to get clicks and isn't even remotely actual journalism.

So in other words, it's Gizmodo?

I know that is scary when here in the US when you don't have medical insurance, but if they had called the emergency number (911) an ambulance and paramedics would have been dispatched and he would have been taken to the hospital quickly and would have received treatment. The hospital would have to treat him, regardless of medical coverage. They would still be charged for the services later, but they would have received treatment.

> They would still be charged for the services later, but they would have received treatment.

And his family would have been bankrupt from the ambulance ride alone, never mind the cost of the treatment. A family that can't afford health insurance for a 17 year old cannot afford healthcare in the US at all. Let alone emergency healthcare. The family almost certainly went to Urgent Care first in hopes of getting their very sick son treatment for $5,000 instead of $50,000 at a hospital.

> And his family would have been bankrupt from the ambulance ride alone, never mind the cost of the treatment. A family that can't afford health insurance for a 17 year old cannot afford healthcare in the US at all. Let alone emergency healthcare.

This ^. I don't have health insurance, I can't afford it right now. If I had covid-19 and I was very serious where the bill would be hundreds of thousands of dollars, I would rather choose to die than to bankrupt my family.

US has one of the highest rates of preventable deaths.

  And his family would have been bankrupt from the ambulance ride alone,

Actually, they could have signed him up for an ACA plan that day, and everything would have been covered. That's why so few healthy young people go without coverage: the twisted economic incentives of how ACA was written reward it.

Talk about an ambulance is a red herring anyway, because the safer choice is for them to drive him to the hospital themselves immediately, and not wait.

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