Arrowman

Discussions in other threads about socialised medicine and "honour codes" cause me to put this story up for consideration.

A friend of mine, a doctor, told me this story. An elderly woman needed a hip replacement. Her (immigrant) family, having been lied to by government propaganda, believed that the public health system in Australia would meet all their needs, so they did not have private health insurance. They were shocked to discover that the public waiting list was about 18 months, so they all chipped in and paid for the operation to be done immediately in the private system.

After the operation, there were complications which put the woman in ICU. Now, don't ask me the details of how it works at this stage, because I don't recall, but here's essentially what happened...

Because the operation had been done privately, the ICU bill was also private - in other words, the family would have to pay. And of course this was going to be megabucks - more than the original operation. Because of the particular circumstances she was not eligible to be transferred to a public hospital - but in other circumstances, she would have been.

The doctors, having seen the family front for the operation, and themselves being no fans of some of the failings of the public system, thought that this family had done enough, and shouldn't have to pay for the ICU bill as well. It was time for the public system to do its share. So they "ticked the right boxes" on the woman's medical record to qualify her for a public ICU bed, and transferred her to a public hospital.

The moral question - the doctors essentially "rorted the system" and lied about the condition of the woman, in order to get her a public ICU place. Were they justified?

Edited to add clarification: The doctors did not conceal the essential nature of the operation, where it was done, who did it, etc. Noone was dodging responsibility, as far as I can recall. The lie was about some detail of the operation and outcome which made the difference on eligibility for a public bed. Sorry, I can't recall more than that.

Psycho Economist

Of course not. It was an unwarranted gamble for them to pay for the operation when they couldn't anticipate the real cost (that's what health insurance is all about in the first place). It was also intollerable of them to make the public pay for their screw-up instead of finding some way to cooperatively fund the bill for the complications as well.

But it is a better alternative than letting her die, or suffer through extensive surgical morbidity... If they truly had no better option, I'd personally just leave them liable to the public hospital for the cost of treatment, and have them pay it off in installments. If they had better options and were just being cheap or lazy about exercising them, I'd leave them in a world of hurt.

"When I am king you will be first against the wall, with your opinions which are of no consequence at all..." and all that.

99Percent

Don't both doctors and patients have the option of paying insurance for these kinds of unexpected events?

cricket

I don't know if "justified" is the word for this; I think it is "understandable". Similar to how an MD might charge for a service if patient is insured, but perform the service free of charge if patient is not covered, as an act of kindness.

Different but similar.

Arrowman

For the patients - they had already opted not to carry insurance. For the doctors - no, we're not talking about negligence here. It is not a case where the doctors were going to be liable for costs, or where their insurance was relevant. There was no negligence - just "shit happens".

cricket: "Understandable" might be right. And that's how I would phrase it, I suppose. But the difference is that this was an "act of kindness" which drew on the public purse. Only justifiable if you share the doctors' view that these people had been badly misled by the government. (This is a view which I believe has some validity - for a while there the government really did advertise a rosy picture of the public system as though you could rely on it entirely without any need for private cover. A grossly irresponsible thing to do, imho.)

Psycho Economist: I think the "unwarranted gamble" is a very good point. In particular, I wouldn't blame the family for that; I think it is more likely the doctors failed to fully inform the family of the possible consequences of their decision, beyond the direct cost of the operation. "There's a 5% chance that this will cost you another $100,000 - now, do you still want to go ahead?" would be good advice, I think.

99Percent

Which might be considered a mistake of which the consequences they must now face. If they were able to spend thousands for the operation, surely they can spend just a little extra for the insurance.And that is why there is precisely insurance - to guard against "shit happens". In fact, insurance will probably not cover negligence. Of which in this case its the doctors complete responsibility to cover for the extra costs and not the state.

Arrowman

Indeed. The thing about the story (imho) is

1. The doctors were negligent in not fully informing the family of the potential total cost of the operation. The family did not make a fully informed decision.

2. Indeed the family could afford insurance. The thing is, that at the time the Australian government was advertising the public health system as a Great And Wonderful Thing for all Australians; this was irresponsible propaganda because as a result many Australians, including those who "should be able to afford it" got sucked in and dropped their private health insurance without realising that the public system could not in fact meet all their needs. We have grown a whole generation of Australians who don't think private heallth insurance is a priority in their budgets, and only now are we starting to correct that.

Well, yes. Private health insurance covers "shit happens and then you go into hospital" (including the ICU stay) and professional indemnity insurance covers "shit can happen to any doctor".

In this case it is not the doctors' "complete responsibility" because they did not screw up. It is their partial responsibility because they led the patient (family) down a path without full information. They then took a decision to "do the right thing" by a family which they (the doctors) felt had been misled by the government, or they could have come to an arrangement for the family to pay the ICU fees in a manageable manner.

Although I do think the doctors were remiss in not providing enough information to the family, I'm not sure this justifies them (the doctors) picking up the ICU bill.

There's no single simple answer to this one.

...

It seems to me that what the OP is really all about is "Is it okay to lie if your intentions are good?".

In this case, maybe. If the woman's life was in danger, and the only thing saving her from recovery was some rule book, then I would have fudged the paperwork. Everyone chipped in for the operation to get this Jane Doe taken care of, thus bypassing the system. Then she needed the system to take care of her again, BUT if the docs told the straight truth, the bureaucrats would have said "that's policy" and forgotten the whole thing.

In this case, all I have to say is "screw policy". A life was at stake (presumably). Life takes precedence over policy. Period.

(OT: Someone once asked me how I should be addressed/referred to on these boards. Call me the Ellipsis or somesuch, I don't care.)

Amie

I agree with Ellipses here