“Did the recording give the name and number of a covering doctor?”
“No,” he said. “I’m not surprised. There aren’t too many pediatricians in the immediate area. What’s suggested in his outgoing message is for anything that can’t wait until he gets back this coming Monday should be seen at the MMH Inwood Emergency Department. He’s made arrangements that the MMH ED doctors have online access to his records if it’s needed for the continuity of care.”
“Might continuity of care be important in Juliette’s case?” she asked.
“It could be,” Brian said reluctantly. “I don’t know for sure, but Juliette was a premature baby and spent her first couple of months in the Children’s Hospital at Columbia-Presbyterian Hospital. That was where we originally met Dr. Bhatt.”
“Okay, that solves it. Let’s have her be seen at MMH Inwood. It might even be easier since they can go ahead and do a Covid-19 test straightaway.”
“I don’t know!” Brian said with a questioning expression. “In the middle of being in for nearly two hundred thousand dollars, the MMH Inwood ED might be the last place I want to take her. Hell, they might even refuse to see her for all I know.”
“They aren’t going to refuse to see her,” Jeanne scoffed. “By law I don’t think they can refuse.”
“Maybe so, but they sure as hell might be less than accommodating or even rude to us.”
“I can’t imagine,” Jeanne said. “The MMH Inwood might be predatory and overly profit centered, but I’ve come to understand there is a definite divide between their clinical side and their billing and collections shenanigans. Not once did I have the impression the doctors doing the day-to-day care had any idea of what was going on on the business side. Of course, whether they should have is an entirely different question.”
“I disagree,” he countered. “With my wife, it was the chief medical officer who saw fit to discharge her, and I’ve been worried it might have been because the hospital wasn’t being paid.”
“Hmmm,” she voiced. “You might be right. Do you know that the position of chief medical officer is a relatively new position in hospitals?”
“I didn’t,” Brian said.
“During my lawsuit and because of my budding interest in business issues when I changed from being a school psychologist to running an alarm company, I’ve spent many hours researching modern-day hospital business practices. It’s eye-opening, to say the least, or maybe horrifying is a better term. One of the things I came to understand was that the chief medical officer, or CMO in hospital jargon, is really an administrator hired by the hospital CEO. Although originally trained as a doctor, the CMO usually has some subsequent business background like an MBA, so their main interests revolve more around hospital costs than clinical outcomes. Although it sounds similar, the chief medical officer isn’t the same as chief of surgery or chief of internal medicine, whose orientation is just the opposite.”
“I had no idea,” Brian said. “I thought the CMO might have been a combined position representing both surgery and internal medicine and still more attuned to what’s best for the patient.”
“No, it’s definitely administrative and mostly geared toward keeping costs down to maximize profits,” Jeanne said. “I hope I’m not boring you with all this economic minutia.”
“Quite the contrary, but you are making me more concerned my wife was discharged prematurely. I feel so naïve about this current medical world.”
“You and a lot of other people. Unfortunately, it’s all about money. The sheer amount of money involved in healthcare attracted private equity because of the sky-high potential profits. It’s the private equity investors who have forced hospitals to hire a bevy of compensation consultants.”
“What the hell are compensation consultants?”
“They are highly trained businesspeople whose sole goal is to maximize revenue,” Jeanne explained. “They don’t care if the company is a hospital or trucking firm. Their shenanigans and advice have contributed significantly to a major uptick in hospital prices and thereby profit.”
“I thought a lot of hospitals were now struggling financially,” he said, realizing he’d been getting mixed information from Roger Dalton.
“That’s true,” she said. “But that’s just since the coronavirus has forced them to cut back on lucrative elective surgery like joint replacements. Otherwise, hospitals, particularly chain hospitals, have been virtual gold mines thanks in large part to their teams of compensation consultants. It’s the community hospitals and rural hospitals, which are still primarily oriented toward patient care and the neighborhoods they serve, that are hurting. They are either going out of business or being snapped up by hospital chains backed by private equity, which quickly turn them into money-making machines. And it’s happening across the country, thanks to all their compensation consultants and CEOs like Charles Kelley. Welcome to the twenty-first century.”
“It all infuriates me,” Brian snapped. “With what you are saying, I’m even more convinced my wife was discharged because of economics. What a disaster!”
“It’s possible,” Jeanne said. “I give you that. But the point I want to make is that the MMH Inwood CMO and the compensation consultants have nothing to do clinically with what happens on a day-to-day basis in the Emergency Department. No one there will have any idea you owe the hospital money or that the hospital is suing you. And to get back to Juliette, I really think she should be seen and seen at MMH with her medical records available if needed and get a Covid test. Actually, what I think will be more of a problem is that she’s going to refuse to go, but I’ll be happy to help convince her if you would like.”
“I’m sure you are right; she won’t want to go. She can be very willful. It’s very generous of you to offer help, which I sincerely appreciate, but why are you, if I might ask without sounding ungrateful?”
“To be entirely honest, it’s mostly because I feel for you having just lost your wife yesterday,” Jeanne said. “I have a visceral idea of what you are going through because of my own recent grief. I don’t know how you are coping as well as you are.”
“Like I said in Megan’s office, it’s with a lot of denial, but I’m also one of those people who needs to be doing something, and Juliette needs me to support her and hold together what I can of our life.”
“I understand,” she said, getting to her feet. “Let’s see if we can get her to cooperate without too much difficulty.”
At that moment his cell phone rang. He answered as he got to his feet, motioning to Jeanne to hold on for a moment. It was Aimée calling from the O’Briens’.
“Emma’s wake is about to start,” Aimée said. “Hannah asked me to call because she wants to know when you and Juliette are going to come over? I know you sounded reluctant earlier, but she thinks it is important for Juliette to say goodbye to her mother and maybe leave something for her in the casket.”
“A problem has arisen,” Brian began, wincing at the whole idea of the wake, particularly in relation to his daughter. He had forgotten all about it with his rising concerns about his daughter’s health status. “Juliette seems to have a fever and doesn’t feel great, making us worry she might have coronavirus.”
“Oh, no!” Aimée exclaimed. “Mon Dieu! What are you going to do? Are you going to have her tested?”
“Yes, I think we must, as it could have dire consequences if she’s positive. We’re going to take her to the MMH Inwood ED.”
“You and Camila?”
“No, with Jeanne Juliette-Shaw, the woman I mentioned earlier,” Brian said. “I called her because Juliette hasn’t been talking, and Jeanne came over and has been very helpful. She was able to get Juliette to open up. That’s how we know Juliette’s not feeling well, because up until then she wasn’t talking. Luckily, she doesn’t have any cough or breathing issues, but what can I say? We can’t ignore it. I tried to call her pediatrician, but he’s on vacation.”