I'm not really all that mysterious

we don't need no stinkin' crash cart

Uh, can you really be a hospital if you can’t perform a resuscitation? Or at least attempt one?

Barbara notes this disturbing story about a “hospital” that has to call 911 when a patient tanks.

Now, in truth, this “hospital” is one of those so-called “specialty hospitals.” There are apparently only 140 or so of them in the U.S., and the whole idea is that they are owned by specialists and are there for elective procedures (read “payments in cash only”)

So cardiologists will open hospitals devoted to catheterization, gastroenterologists will open hospitals that only take patients getting endoscopies, and orthopedic surgeons will open hospitals (like the one on the story) focused on spinal surgeries or maybe arthroscopies, or what not.

On one hand, it is a known fact that if you do one or two things, and do them often, and don’t waste time mucking around with other things, you get really good at those one or two things. A general surgeon who does ten million hernia repairs and nothing else gets really good at doing hernia repairs, but if you’re also doing Whipple procedures and hemicolectomies, you won’t be able to get as many hernia repairs done, and you simply won’t be as good.

On the other hand, there is something disturbing about opening up a hospital for the sole purpose of making money (because, since these are elective cases, they are by definition not emergencies.) While, yeah, we live in a capitalistic society, and all that bullshit, I’m not so sure that medical care doesn’t fall under the same rubric as fire prevention, police protection, or sewage. While we still pay taxes to provide for these services, it’s not like there are fire departments or sewage treatment plants out there competing for your business. Can you imagine directly hiring the police to “protect and to serve”? (Oh, wait a minute, maybe that’s a bad example…)

In any case, the existence of EMTALA makes it evident that at least some legislators believe that health care is in fact a right and not a privilege. (EMTALA is a law that covers any hospital that accepts payment from Medicare, making it illegal for them to refuse to treat patients, even if they can’t pay. The main goal of this law is to prevent the ugly practice of “dumping,” where for-profit hospitals used to literally throw people out and turf them to County or the nearest charity hospital, even if they were crashing or bleeding out. Some believe that “dumping” hasn’t really been quite eliminated, it’s just more surreptitious, that’s all.)

So I’m not a big fan of these specialty hospitals. The sad things about the U.S. is that we have the most advanced medical technology in the world, but most of us (even when insured!) end up getting treatment that is on par with many Third World nations. True, we physicians need to make a living, too, and working for free is not anyone’s idea of a good time, but at the same time, I don’t think people should have to make a decision as to whether they live or they die depending on how much money they have.

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