美国国家公共电台 NPR Bill Of The Month: $43,208 For Repeat Surgery To Replace Broken Medical Device

 

DAVID GREENE, HOST:

So here's a question - what do you do when a medical device fails? And when it fails, who pays for it - the manufacturer, the hospital? Or are you stuck with the bill? Well, Dr. Elisabeth Rosenthal from our partner Kaiser Health News has been looking into this as part of our medical Bill of the Month series. This is when you, our listeners, bring us mysterious and inflated¹ medical bills, and we try to dissect² what happened. Dr. Rosenthal, welcome back to the program.

ELISABETH ROSENTHAL: Hi. Thanks for having me again.

GREENE: All right. So this month's bill involves someone who essentially³ had to have the same surgery twice because a medical device failed. That sounds terrible.

ROSENTHAL: That's right. And she had to pay for it twice. Today, we're going to meet Sarah Witter, a retired⁴ teacher in Vermont who loves skiing. She's still skiing in her 60s.

GREENE: Nice.

ROSENTHAL: But she had an accident earlier this year that sidelined her for a while.

GREENE: You and I are going to talk about the bills she ended up paying, but let's actually hear what happened to her. Nina Keck from Vermont Public Radio went to visit with her recently.

NINA KECK, BYLINE⁵: Sarah Witter and I are sitting at her dining room table. To her right is a stack of medical bills. We'll get to those. But first, she wants to show me what's inside a large manila envelope.

SARAH WITTER: Since, in my eyes, the whole thing is about this.

KECK: This is a rather ordinary looking piece of hardware, about six inches long and bent⁶ up at one end.

WITTER: Sort of looks like a curved tongue depressor with one, two, three, four, five, six, seven, eight different shaped holes.

KECK: Those are meant for surgical⁷ screws, but there's also a gaping⁸ crack that's not supposed to be there. But let's back up to last February. Sarah was skiing with her husband when she took a hard fall. Ski patrollers had to bring her down on a toboggan. And doctors at a nearby clinic took X-rays of her leg.

WITTER: They saw right away that it was a bad break.

KECK: An orthopedic surgeon at Rutland Regional Medical Center told her she had a pilon fracture.

WITTER: Broken and sort of crushed - similar to the kind of accidents that skydivers get if they hit the ground too hard.

KECK: Wow.

WITTER: And I generally don't go in the air when I ski. But anyhow, I could - you could see little pieces.

KECK: This is where that odd shaped bit of hardware known as a locking plate comes in. Sarah's doctor used it to hold all those little pieces together. The surgery went great, the doctor told her, but to heal properly, the 63-year-old had to stay off her feet for 12 weeks - the hardest part. Moving anywhere meant using a walker she renamed the hopper.

WITTER: I developed calluses on my hands from holding the walker and hopping⁹ so much.

KECK: After three months, things were better, but then her leg began to painfully throb¹⁰ in a whole new way. After an X-ray, her surgeon broke the news. The steel plate had broken. She'd need surgery all over again.

WITTER: I don't know how it broke. He did - the first thing he said to me was it wasn't anything I did. So he said it just happens.

KECK: But unlike when a car part or some other costly¹¹ appliance fails, Sarah learned there was no warranty¹² on the hardware used on her leg. In fact, the Witter's insurance would be charged nearly $100,000 for her treatment, of which Sarah and her husband had to pay nearly $19,000.

WITTER: You know, I'm ruffling¹³ through approximately 50 pages of gobbledygook that I don't know how anyone can understand it.

KECK: But here's what we did find out. That second plate cost nearly $13,000, and Sarah thinks the hospital or the manufacturer should have paid for it.

WITTER: They made it. It broke. You know, if my coffee maker¹⁴ broke, I'd go back to the coffee maker or manufacturer and say, hey, you owe me a new one. You know, they can't give me back my time and all the discomfort¹⁵ and the weeks in the chair. But I do think for the billing of the surgery, they should do something.

GREENE: All right, listening there to a story from Nina Keck from Vermont Public Radio, and I'm still with Dr. Elisabeth Rosenthal from Kaiser Health News. And that - what we heard from her at the end there seems to make sense to me. They made it. It broke. But that's not the way it works with medical devices.

ROSENTHAL: Well, not at all. With medical devices, usually patients and insurers foot the bill if something goes wrong or breaks. And, you know, that - sometimes in medicine, that may be OK. Like, if you're prescribed the wrong antibiotic¹⁶ the first time and it doesn't work, you go buy another one - not a big deal. But in this case, as we heard, the replacement¹⁷ part for the $9,000 plate that broke was $13,000. And instead of saying, gee¹⁸, sorry, you know, we'll take care of it, both Sarah and her insurer were billed a whole lot of money. So, you know, we all expect warranties¹⁹ from the electronics store, from a car dealership²⁰, from a builder, but that isn't the norm for medical devices, and we accept that. You know, what I like to say is in commerce, generally, the customer is always right; in medicine, the customer/patient is always wrong.

GREENE: Yeah, which doesn't sound fair. Why is that the way it is?

ROSENTHAL: Well, it's just become the norm in medicine, and it's not just the cost of the device. Of course, to get the device replaced, she also had a $50,000 hospital bill. So everyone kind of conspires²² against the patient in this case.

GREENE: OK. So you said the insurance companies maybe would have covered this in the past. What did Sarah Witter hear from her insurance company in this case?

ROSENTHAL: Basically nothing, you know, that this is how it works.

GREENE: OK. So she's stuck with this big hospital bill. She's stuck with the bill because of - the surgery went badly. Her insurance company is paying some of it. She's still stuck with paying a lot of money. Is there anything she can do here?

ROSENTHAL: Yeah, there are some things. First of all, if it's an elective surgery, some places are starting to offer warranties. If your artificial hip²¹ dislocates within the first year, they'll do it for free. That is reasonable, right? The other thing I tell people to do is fight the good fight. Don't give up on this. You know, you should not be paying twice because of someone else's fault. And, you know, your insurer may not go to bat for you, but ask the HR department at your company because they're paying and they should fight like hell against this.

GREENE: Is she at least back on the slopes yet as she's fighting the good fight and enjoying some skiing?

ROSENTHAL: Not quite yet. She's still healing, but you can see her out on the slopes working at the ski resort, so she will be back by next year.

GREENE: So she's at least getting back into that atmosphere that she loves. All right, Elisabeth Rosenthal is editor in chief of Kaiser Health News. Thanks as always.

ROSENTHAL: Thank you.

GREENE: And if you have a medical bill that seems mysterious or inflated or something that concerns you and you want us to take a look at it, go to our Shots blog on npr.org and just submit it to us online.

(SOUNDBITE OF OSKAR SCHUSTER'S "MARIBEL")

1 inflated   

adj.（价格）飞涨的；（通货）膨胀的；言过其实的；充了气的v.使充气（于轮胎、气球等）( inflate的过去式和过去分词 )；（使）膨胀；（使）通货膨胀；物价上涨

参考例句：

• He has an inflated sense of his own importance. 他自视过高。
• They all seem to take an inflated view of their collective identity. 他们对自己的集体身份似乎都持有一种夸大的看法。 来自《简明英汉词典》

2 dissect   

v.分割；解剖

参考例句：

• In biology class we had to dissect a frog.上生物课时我们得解剖青蛙。
• Not everyone can dissect and digest the public information they receive.不是每个人都可以解析和消化他们得到的公共信息的。

3 essentially   

adv.本质上，实质上，基本上

参考例句：

• Really great men are essentially modest.真正的伟人大都很谦虚。
• She is an essentially selfish person.她本质上是个自私自利的人。

4 retired   

adj.隐退的，退休的，退役的

参考例句：

• The old man retired to the country for rest.这位老人下乡休息去了。
• Many retired people take up gardening as a hobby.许多退休的人都以从事园艺为嗜好。

5 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

6 bent   

n.爱好，癖好；adj.弯的；决心的，一心的

参考例句：

• He was fully bent upon the project.他一心扑在这项计划上。
• We bent over backward to help them.我们尽了最大努力帮助他们。

7 surgical   

adj.外科的，外科医生的，手术上的

参考例句：

• He performs the surgical operations at the Red Cross Hospital.他在红十字会医院做外科手术。
• All surgical instruments must be sterilised before use.所有的外科手术器械在使用之前，必须消毒。

8 gaping   

adj.口的；张口的；敞口的；多洞穴的v.目瞪口呆地凝视( gape的现在分词 )；张开，张大

参考例句：

• Ahead of them was a gaping abyss. 他们前面是一个巨大的深渊。
• The antelope could not escape the crocodile's gaping jaws. 那只羚羊无法从鱷鱼张开的大口中逃脱。 来自《简明英汉词典》

9 hopping   

n. 跳跃 动词hop的现在分词形式

参考例句：

• The clubs in town are really hopping. 城里的俱乐部真够热闹的。
• I'm hopping over to Paris for the weekend. 我要去巴黎度周末。

10 throb   

v.震颤，颤动；(急速强烈地)跳动，搏动

参考例句：

• She felt her heart give a great throb.她感到自己的心怦地跳了一下。
• The drums seemed to throb in his ears.阵阵鼓声彷佛在他耳边震响。

11 costly   

adj.昂贵的，价值高的，豪华的

参考例句：

• It must be very costly to keep up a house like this.维修这么一幢房子一定很昂贵。
• This dictionary is very useful,only it is a bit costly.这本词典很有用，左不过贵了些。

12 warranty   

n.担保书，证书，保单

参考例句：

• This warranty is good for one year after the date of the purchase of the product.本保证书自购置此产品之日起有效期为一年。
• As your guarantor,we have signed a warranty to the bank.作为你们的担保人，我们已经向银行开出了担保书。

13 ruffling   

弄皱( ruffle的现在分词 )； 弄乱； 激怒； 扰乱

参考例句：

• A cool breeze brushed his face, ruffling his hair. 一阵凉风迎面拂来，吹乱了他的头发。
• "Indeed, they do not,'said Pitty, ruffling. "说真的，那倒不一定。" 皮蒂皱皱眉头，表示异议。

14 maker   

n.制造者，制造商

参考例句：

• He is a trouble maker，You must be distant with him.他是个捣蛋鬼，你不要跟他在一起。
• A cabinet maker must be a master craftsman.家具木工必须是技艺高超的手艺人。

15 discomfort   

n.不舒服，不安，难过，困难，不方便

参考例句：

• One has to bear a little discomfort while travelling.旅行中总要忍受一点不便。
• She turned red with discomfort when the teacher spoke.老师讲话时她不好意思地红着脸。

16 antibiotic   

adj.抗菌的；n.抗生素

参考例句：

• The doctor said that I should take some antibiotic.医生说我应该服些用抗生素。
• Antibiotic can be used against infection.抗菌素可以用来防止感染。

17 replacement   

n.取代，替换，交换；替代品，代用品

参考例句：

• We are hard put to find a replacement for our assistant.我们很难找到一个人来代替我们的助手。
• They put all the students through the replacement examination.他们让所有的学生参加分班考试。

18 gee   

n.马；int.向右！前进！，惊讶时所发声音；v.向右转

参考例句：

• Their success last week will gee the team up.上星期的胜利将激励这支队伍继续前进。
• Gee,We're going to make a lot of money.哇！我们会赚好多钱啦！

19 warranties   

n.保证书，保单( warranty的名词复数 )

参考例句：

• I read and compare warranties before purchasing. 我在购买前阅读和比较保修单。 来自超越目标英语 第4册
• One way of ensuring reliability is insisting on guarantees and warranties. 要确保产品可靠性的一个方法，就是坚持制定产品的品质保证条款。 来自互联网

20 dealership   

n.商品特许经销处

参考例句：

• The car dealership has a large inventory of used cars. 这家汽车经销商拥有数量庞大的二手车。
• A key to this effort is the experience in the dealership. 达到这个成果的关键是销售的体验。

21 hip   

n.臀部，髋；屋脊

参考例句：

• The thigh bone is connected to the hip bone.股骨连着髋骨。
• The new coats blouse gracefully above the hip line.新外套在臀围线上优美地打着褶皱。

22 conspires   

密谋( conspire的第三人称单数 )； 搞阴谋； （事件等）巧合； 共同导致

参考例句：

• You speak as if all Sparta conspires against you. 你说得好像整个斯巴达在共谋对抗你。
• The mystical organization syndicate, conspires to harass the social order. 神秘组织辛迪加，密谋扰乱社会治安。