Meth-related burns a growing part of uncompensated care at Vanderbilt
Posted: Thursday, August 12, 2010 10:25 pm
By JOHN BRANNON
Are Dr. Jeffrey Guy’s words — “We can turn this light switch off” — mere speculation? Or a warning?
Dr. Guy is trauma surgeon and director of the Burn Center at Vanderbilt University Medical Center, a 29-bed facility that treats severely burned victims received from throughout the Mid-South. A third of those under treatment are victims of meth lab explosions. The “labs” are clandestine places where miscreants attempt to manufacture the potent but illicit drug, methamphetamine.
Many of the burn victims arrive with second- and third-degree burns. Treatment, if they survive the burns, can last as long as six months and cost as much as $1 million.
Much on Dr. Guy’s mind is the “black hole” that sucks in big bucks spent by the hospital in providing treatment to patients who, for whatever reason, are unable to pay. Hence, the term, “uncompensated care.”
The numbers tell a story. The numbers are staggering.
John Howser, Vanderbilt University Medical Center director of news and communications, said the financial performance of each clinical program is “tracked” on a year to year basis.
He said that in fiscal year 2008-09 (July 1, 2008-June 30, 2009), uncompensated care provided by the Medical Center totaled $275 million.
In fiscal year 2009-10 (July 1, 2009-June 30, 2010), it skyrocketed to $325 million.
“That’s institution wide, not just the Burn Center, but for all our hospitals and clinics,” Howser said.
And what’s the dollar figure for uncompensated care at the Burn Center? “I don’t know that we could or would want to single that out,” Howser said. “The Burn Center is a resource for the entire state of Tennessee. So we have a commitment to Vanderbilt to maintain that service.”
Dr. Guy said the public needs to keep this one thing in mind: Vanderbilt University Medical Center is a private entity.
“The trustees of the university don’t have any statutory requirement to continue providing this kind of care,” he said. “They can just simply say, ‘We are done.’ That’s all that will be required, saying, ‘We’re done.’
“So we would not be doing burns. They could turn the burn unit into a Detox unit, or something for country music stars, something that pays.
“That’s what people seem to lose track of. This is a private hospital at a private university doing almost $300 million a year in uncompensated care.”
Has there been any high-level discussion about closing the Burn Center?
“Here’s how I would answer that question,” Howser said. “It’s not a yes or a no. The financial performance of the different clinical programs are evaluated periodically. Because of the uncompensated care burden that we shoulder here at Vanderbilt, we have to be mindful of the financial performance of these programs.”
A high cost
If a patient is indigent, who pays the hospital bill?
“We all pay,” Dr. Guy said. “Most of these patients are totally uninsured. (Treatment) requires a huge amount of health care resources. The reality of it is, it’s passed on to the rest of us who do pay. Health care reform has done nothing (to address it).”
He gave some examples of the treatment costs. For the most minor patient — meaning one who is in and out quickly, without surgery — it’s at least $10,000. In those cases involving larger burns, expenditures are well in excess of $1 million.
“For the big burns, we’re spending over $10,000 a day just to keep him (a patient) alive. Then we go through dozens of operations and putting him back together again,” Guy said.
Beyond the doors
Guy said there’s an expectation that when a patient is discharged from the Burn Center, Vanderbilt will pay for supplies such as dressings and equipment and medications. It’s a situation where the hospital is not only providing medical care for free, it’s also expected to take care of patients beyond the hospital doors.
“In some cases we are able to give them their medicines, but it’s not something we can perpetuate. We can maybe do a first prescription,” he said.
In a larger sense, he added, Vanderbilt really is paying to take care of people, “because the stuff we use costs money.”
“We have to buy it from vendors and suppliers and then we give it to patients who don’t have any ability to pay,” he said. “That’s part of our clinical mission, and we are not complaining about doing our mission. There needs to be the realization that the magnitude of the mission is profoundly expensive.”
No way to recoup
The center takes in “people who have nothing,” Dr. Guy said. “They have no health insurance, they are denied access to TennCare. So we end up paying for it. The reality of it is, those are the things that are part of the debate over the last two years. The expenses are passed on to those who pay — the consumer.”
Howser said it takes only a few million-dollar cases — “a small number of patients — to adversely affect the Burn Center’s bottom line. “I understand Dr. Guy’s position,” he said.
“We are dealing with the physical manifestations of a cancer,” Dr. Guy said. “If you want to solve this problem, you have to attack (it) head-on. We are hemorrhaging money taking care of these people who are exploding because the injuries are physically tangible. We can’t let people lie on the street, dying of massive third-degee burns. But the reality is, we are allowing people on the street to die of the problems of their drug addiction and psychological disorders. That seems a lot more tangible to people.
“The other element of this is, people say, ‘Well, you know, they’re just drug addicts. Let them blow themselves up.’
“What people don’t realize is that now they’re doing this in cars and parking lots and hotel rooms.”
John Brannon may be contacted by e-mail at firstname.lastname@example.org.
Published in The Messenger 8.12.10