A series of questionable bills from Valley Regional Hospital needs investigation

It has happened to us.

Rick Anscomb’s experience with Valley Regional Hospital happened to us.

A February 20th Herald article “Man was in no state to sign NSHA document, wife says” tells how Anscomb of Kingston suffered a stroke, was rushed to Valley Regional Hospital in Kentville on December 11 and charged for his hospitalization.

https://www.thechronicleherald.ca/news/provincial/valley-man-was-in-no-condition-to-sign-nsha-document-wife-says-413030/

Sharon Anscomb has no problem with the medical care he received, but is furious that they were charged $510 for his hospitalization. Insurance paid $420 and she refuses to pay the outstanding $90 because they maintain the stroke incapacitated him and he didn’t know what he was signing. Sharon wasn’t present when the paperwork was done.

Scanning The Chronicle Herald files I found a November 6, 2018 article “New Mom ‘high as a kite’ when signing $13,000 hospital bill.” The article details how 24-hours after an emergency cesarean section, Beverly Burns, a Nova Scotian living in South Korean, was given “a pile of documents to sign”. She told reporter Nicole Munro, “I didn’t know if it was a nurse or a doctor I was speaking with and I don’t know what they said to me because I was out of it.”

https://www.thechronicleherald.ca/news/local/new-mom-high-as-a-kite-when-signing-13000-hospital-bill-257193/

This seems to be a pattern with Valley Regional Hospital, and perhaps the NSHA. It happened to us. Our bill was for $2,945.

On October 30, 2017 my sister was taken by ambulance to Valley Regional Hospital (VRH). She was diagnosed with a Bilateral Cerebellar Infracts (a rare type of stroke). As well as being disorienting it impaired her vision. She had surgery right after the stroke, followed by two subsequent surgeries which helped restore some, not all, of her vision.

In the VRH ER she was given six drugs, sent for a CT scan and put on two courses of Ringers Lactate (R/L).

The drugs given her list dizziness, drowsiness and confusion among their side effects. One of the drugs is the equivalent of valium.

Medical professionals tell me that multiple rounds of Ringers Lactate show how dehydrated she was. The R/L continued for two more days. I’m told when you are that dehydrated you aren’t coherent and are too disoriented to be considered competent.

Yet, after all this a VRH admissions clerk decided my sister, like Anscomb and Burns, was legally competent to sign a request form for a semi-private room. The request form states she was willing to pay $150/night for the room. This contract was signed without a witness other than the admissions clerk and without the knowledge of her husband who had briefly left her bedside. Only after she left hospital when the $2,945 bill arrived for a 20-night hospitalization did we learn of this request form.

In response to Anscomb’s experience an NSHA spokesman suggested people contact the authority Patient Relations line. And mentioned payment terms can be arranged. It wasn’t the money it was the principle and legitimacy of the bill. Sharon Anscomb made the call and says she wouldn’t again waste the time trying to talk the NSHA.

We all wonder how sick you have to be to qualify for free health care? A Yarmouth doctor told me “only 3 in 20 of our beds are public.”

This doctor said, “Ah, the deviousness of bean counters. The beds other than the three bedded units are a mixture of doubles and singles, there is a charge to occupy these. Now if the only available bed is one of these, they can’t charge, but happened often enough that the hospital would put someone in the three bedded unit, and they’d rather pay the extra money so they could sleep at night. Given that 98% of the beds are now occupied all the time, and there are patients in lounges and corridors this doesn’t happen often. But when the hospital was planned, the management was told this was a way to increase the hospital’s income.”

We challenged our VRH charge. An NSHA fax to Kings North MLA John Lohr’s constituency office listed my sister’s diagnosis as “vertigo” and maintained the room charges were correct. Vertigo is one of the multitude symptoms of a Cerebellar Stroke. The NSHA billing department seems to have cherry-picked this symptom to focus on as the cause for her hospitalization.

We continued to challenge the NSHA on this bill. From our perspective she was in no state to enter into a contract. She was traumatized by both the stroke and loss of sight. The medical notes of the day say she couldn’t sit up unassisted.

On May 11, 2018 Marlene Morrison, accounts receivable manager, collections and inquiries, wrote my sister “Mr. Lynch indicated that there may have been a medical condition that rendered you incapable of signing this form. Based on that concern, we had a medical team review your chart and they confirmed there was no medical reason that would have prevented you from signing the form at that time.”

Morrison’s letter, which has no address or telephone number, said, “Our Credit Management Clerk, Theresa Driscoll, will reach out to you to set up a payment plan within the next two weeks.”

May 26, 2018 Driscoll requested payment and added, “If payment is not received within 20 days, your account will be forwarded to Service Nova Scotia for collection.”

We refused to pay the $1,805 balance – an insurance policy had paid $1,140. Service Nova Scotia requested the Canada Revenue Agency apply any tax refunds and credits to the debt. The CRA says this is allowed under subsection 164(b) of the Income Tax Act.

With every fibre of our bodies we don’t believe this is a legitimate charge.

With my sister’s and brother-in-law’s written permission I got my sister’s 1.5-inch-thick hospital chart. That’s how I know what medications she was given, when and how seriously dehydrated she was.

I asked the NSHA what training the admissions clerk had to judge competency? Like most young people, the admissions clerk has her life spelled out on line. Her previous employment was in a New Minas sushi restaurant and Halifax sex shop. Work is work, but what specific training and experience has she in judging competency?

I asked who gave this clerk permission to access my sister as she lay in the ER? Can just anyone employed by the NSHA walk into a treatment room or does a member of the medical team give permission. And if a doctor or nurse gave permission, who was it? And why didn’t anyone speak to her husband who was only out of the room for a few minutes? And why didn’t that medical professional witness the signature and vouch for the patient’s competency?

On February 21 I found Morrison’s email address and asked for the names and qualifications of the medical team she claims reviewed my sister’s medical chart and concluded she was competent to enter into a contract.

In addition to my sister’s medical chart, I also have a copy of the NSHA Record of User Activity report. This lists the names, times, dates and reasons for NSHA staff to access a patient’s medical chart.

I can’t see where any cluster of doctors had visited the chart to conduct the review Morrison claims took place. However, I did see overlapping views of the same set of pages by 13 clerical, accounting and management staff, including Morrison, who read 19 pages. I checked with the College of Physicians and Surgeons of Nova Scotia. They have no prohibition on patients knowing such information.

Erin Beaton, Director for Quality, Safety and Patient Relations for the Western Zone responded. “In April 2018, a medical review was completed by Dr. Lois Bowden Western Zone Executive Medical Director, Dr. Rebecca Brewer Emergency Department Physician, and Tim Murray Manager of the Emergency Department. Robyn Llewellyn, Assistant Manager of Health Information Services along with Linda Plummer, Director of Health Information Services, thoroughly reviewed the admission process.”

Beaton’s letter continues, “the clerical process the Health Records admitting clerk followed that day aligns with the NSHA admissions process. The process requires the admitting clerk to confirm with nursing staff if the patient can be seen and is capable to understand and answer questions. If not, the clerk then inquires if there is a delegate (next of kin, or family member). At that time, there were no concerns related to capacity or competency therefore the admitting clerk proceeded with the process by seeing the patient. This includes confirming all patient information, whether the patient would like to request semi‐private or private accommodations and if they have private medical insurance. The clerk explains there is a fee for these accommodations if they are requested. It is not the clerk’s responsibility to know what type of coverage a patient has or if it covers the complete cost.”

“Based on the extensive clinical and administrative review, NSHA considers this file closed and the amount charged remains on the account.”

The NSHA description of “semi-private or private accommodations” makes it sound like the patient is checking into a hotel rather than being so ill they need to be hospitalized.

Beaton, like all bureaucrats, is focused on “process”, in this case the “admission process” vs medical condition and legal competency.

A problem with Beaton’s position is that it’s wrong. She may be accustomed to people accepting her word, but I fact check everything. The NSHA Record of User Activity report didn’t list Dr. Brewer accessing the chart in a three-month window when we originally complained about the bill.

I contacted Dr. Brewer. She emailed, “I did not review her file.  …  I am not sure why my name was included in the letter you were given.”

Since the NSHA is wrong about the medical review panel, what else are they wrong about?

Another question I have is whether the NSHA’s admission process meets the legal standard for binding contract since people being admitted to hospital from an ER are at their most vulnerable and often highly medicated? What legal opinion have they to support their position that the process is sufficient? They seem to have established a low bar for competency.

Retired medical professor and retired family physician Dr. David Zitner has reviewed my sister’s chart. Reading the Interprofessional Notes – where doctors record their daily patient observations – Zitner says, “The October 31and Nov 1 notes suggest problems that would interfere with the ability to read and sign forms.”

“She had double-vision. It’s documented. She had to be under supervision. There is nothing in the documentation to indicate she was compos mentis to sign the form.”

Zitner also said it is not clear why Ativan, a Valium-like drug, was given and notes it can impede competency.

After reading the charts he said, “It seems crazy to me that anyone from NSHA would persist in demanding payment.”

The bottom line is that I believe we were improperly charged and that the NSHA haven’t been honest with us. The NSHA bureaucracy seems incapable of admitting when they are wrong. Or when caught. They can’t claim it is a one-off mistake since so far we know of three questionable cases: Anscomb, Burns and us.

If it happened to us, Anscomb and Burns, how many other questionable contracts exist? Who else in Nova Scotia have either been improperly billed for care or denied access to care because they couldn’t afford to pay?

There is another troubling thread to this. Burns is from Greenwood, which suggests a military connection. Anscomb is retired from the military. My sister’s medical chart mentions “husband was engineer with military (pension)” and “pt [patient] has a small pension from previous husband (DVA)” then details their insurance plans. It seems lot of financial notes were gathered and suppositions made for a free health care system.

Given the reticence of the NSHA to admit their mistakes, it would seem reasonable that the Auditor General to investigate how many Nova Scotian patients and families face questionable medical bills. The NSHA isn’t about to do it.

In the meantime, for those who feel they have been improperly charged for care, ask to see the medical chart. Pay attention to the day of admission, the nurses’ and doctors’ comments and medications administered. That lays the foundation for the level of need and ability for informed consent by a patient.

In the meantime we have a $3,300 bill for a second hospitalization. Valley Regional is turning in to a good little earner for the NSHA.

 

 

 

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5 Responses to A series of questionable bills from Valley Regional Hospital needs investigation

  1. Bubbie says:

    It is becoming apparent because the provinces sign individual bilateral health funding agreements with the national government we do not have a national health accord and health care between provinces is like traveling to a different country where fees can be applied for health care services. It is becoming necessary to take out travel insurance when travelling to neighbouring provinces and it is the fault of the provinces signing bilateral agreements and now the door to privatization for our treasured social health care system is being opened.
    The ACE Team has been advocating to have a new National Health Accord reinstated so that health cares coverage would be exactly the same in every province. Nova Scotia lost a billion dollars over ten years in the last round of talks with the federal government and bilateral agreements hammered out with all the other provinces where treatment can vary between provinces. We may have a National Health Act but it means nothing without a National Health Accord.

  2. Bernie says:

    We are collectively fortunate that the writer has the knowledge and tenacity to identify and fight this issue. There is so much secrecy involved in NSHA operations that much of this usually goes unnoticed. I certainly support the logical request for an Auditor General’s review.

  3. Violet says:

    Dear Mr. Lynch
    Thank you for your article. I’m deeply sorry for what your family went through regarding Valley Regional Hospital’s admitting policy. As a recent hire, allow me to give you some insight behind the failures that are still going on in the admitting process:

    Your article mentioned that Robyn Llewellyn, assistant manager of Health Information Services for VRH, SMH, ACHC, EKM and WKM was part of the medical review. This is laughable as Ms. Llewellyn has no firsthand knowledge or hands-on training of any aspect of the admitting process and defers all instruction of the matter to her subordinate, Tina Winter (Health Information Clerk Team-Lead). Ms. Llewellyn is on site at VRH hospital maybe two days a week at the most. She does not interact with her staff except in the most cursory of “hellos”, she is ignorant of the Code of Conduct policy, and -in my admittedly biased opinion- completely ill-suited to this position.

    That said, Health Information Services is responsible for the Admitting process just as it is responsible for walk-in patient registration and for the switchboard. The admitting clerk performs all three tasks during a shift, making the position highly stressful. When a patient such as your sister comes to the hospital, we are immediately notified from the FRA (Facility Resource Administrator) via cellphone. We enter the data into our online platform called MEDITECH and print off a copy and attach it to a photocopy of the admitting form you are no-doubt familiar with. We immediately go to Emergency or to the bed of that new patient to confirm the following: Name, address, birth date, telephone, doctor, insurance. More times than not, no nurse is around to confirm if we can talk to the patient. We have to use our own discretion on the matter. We ask the questions if the patient is coherent. If not, we ask whoever has accompanied them. If they are alone and non-lucid, the paperwork is placed in a folder for later follow-up by myself or a co-worker. Sometimes this paperwork can remain in the folder for a week or more.

    When there is a suitable line of communication, it is up to the clerk to confirm insurance details. The policy number is entered into MEDITECH and onto the admitting form. We are instructed to make it crystal clear to the patient that, if they chose semi-private or private accommodation, that they are liable for any incurred costs not covered by their insurance. They are asked to initial two places as confirmation of their understanding on this document before signing and dating it. This completed information is then sent to finance.

    I’m not sure where, in that process, the hospital failed you but I have seen some colleagues not adhere to the practice shown above. HIS has high-turnover and new hires frequently forget to ask the right questions. On one occasion I saw a coworker forge initials when they failed to secure them rather than bother that patient a second time.

    My attempts to bring such lapses to Ms. Llewellyn’s attention marked me as a troublemaker and I was subsequently fired despite having union representation at that time. I would absolutely love to discuss this matter with you in more detail should you wish to pursue it further.

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