Misdiagnosis- Anything to do?

I know a lot of you are in the medical field and will tell me the truth about this situation (even if it is to hiss at me)....

My DH ended up in the emergency room with severe stomach pains 8/25. The doctor on that night did some blood work, Xrays and an ultrasound. Since DH had an appendectomy in 2001 and his liver count was slightly elevated the doctor expected to find gallstones. When the Ultrasound revealed nothing he diagnosed Chris with Hepatitis A, sent the blood panel off and sent us home with pain killers. The only catch is his liver count was only 100 and Hepatitis A usually puts it at 1000. His white blood count was around 10,000 which our family practice doctor said is high, but not a clear sign of infection.

Chris spent all weekend in a lot of pain. We thought the doctor was right and it was the Hepatitis running its course. Monday we both went to our family practice doctor who gave me the Hepatitis vaccine and decided to do a second blood panel on Chris. At this point the pain was intensifying and Chris was not displaying any signs of jaundice. We went home with the blood work on rush. That night Chris' pain continued to intensify and he was vomitting. We gave him some phenegran (sp?) and paged the doctor who said to come in first thing in the morning without an appointment. Once we got there Tuesday Chris' stomach was distended and his bloodwork showed his liver was not really inflamed anymore. The bloodwork also showed his white blood count was now at 14,000. The doctor sent us on our way to a different hospital.

At the hospital Chris had a CT scan which revealed two abscesses in his abdomin. One was 8 cm and near his pelvis. The second was 3 cm but wrapped around his colon. They did a CT guided aspiration (really cool to all the radiologists) and installed a drain on the pelvic one. They attacked the smaller one with 3 antibiotics and waited for results on the bacteria. It turned out to be a strep bacteria and they kept him until Sunday. Now Chris is on Augmentin and getting much better. He has a follow up CT scan on Friday to see how the abscess they couldn't drain.

Here is my long delayed question.... We have received approximately $400 in bills for the first ER visit. I don't want to sound litigation happy because health insurance is high due to all the malpractice suits, but for us $400 is A LOT of money. Chris has only been out of school one year. He just got a job that pays well enough to establish ourselves (he has been working retail while trying to find something better). I don't want to go to collections for not paying, but I am really irked the doctor didn't do a CT scan. Even my best friend in Med School was suggesting his liver count should have been 1,000 (before I told her the count) and was questioning why a CT scan was not done since it would show the most things. She agreed the Ultrasound was the best bet when it sounded like gallstones, but was confused they left it at Hepatitis A without a higher liver count.

Chris is getting better and the bottom line is that is what matters. I don't care about suing because no serious damage was done, just some extra suffering. Is there at least a way to complain about the care at the hospital? I just hate paying it blindly, we should receive quality care for our money.

You could contact JCAHO -

http://www.jointcommission.org/GeneralPublic/Complaint/

I would definitely call the hospital administrator and complain. You might already know - but hospitals agree to collect a LOT less from insurance companies than they charge us regular folks. They might give you the insurance company rate. It was clearly malpractice on their part to send you home. If he had been admitted, would you have had to pay the emergency room bill? Some insurance companies waive the ER bill if it results in admission.

Hi, Amanda,

First off, how scary for you both, and I'm sorry Chris had to endure so much suffering. I hope he's feeling better, day by day.

I agree it's unusual to diagnosis hepatitis without elevated liver enzymes. I also agree it would be a very good idea to talk to a hospital administrator. Be calm and clear, perhaps write down what you want to say before you call. Tell him or her clearly what your purpose is in calling. Do you want to make them aware of the mismanagement alone, or do you want the bill reduced as well? The more clearly and calmly you can talk with them, the more likely you are to get what you want. A hospital should have what's called an "ombudsman", someone who works on behalf of the patient to help resolve problems. If you don't feel satisfied by your talk with the administrator, I would ask to be put in touch with the ombudsman.

Best wishes, Lise

I would contact the hospital's billing/adminstration department and tell them what happened. Explain you are really unhappy about paying $400 for a misdiagnosis that results in a weekend of pain and additional medical bills. Most hospitals are willing to compromise a medical bill if there is a possibility of a mal-practice claim.

Before making a big deal out of this, was the first doctor negligent? Should he have found the problem or was additional workup needed? Did they recommend seeing a specialist and getting further tests? Ordering CT scans when a patient is not insured can be a problem. What if nothing was found? Would you then have been willing to pay the $1200 charge for the CT Scan?

The problem is for $400 it's not worth pursing a claim or getting an attorney. Most hospitals will allow you to make payments over time - say $100 a month for 4 months. Hospital I've found, are usually willing to work with you not against you.

Thank you all for the advice/insight, I knew I would get good advice here. I think there were a few things that were not clear in my first post.

We have do have health insurance. The $400 is our deductible, co-pay and the 10% of the X-rays/Ultrasound. If he had been admitted Friday night, the ER co-pay would have been waived because we would be billed through the hospital.

I guess the correct diagnosis did end up being a little off the wall. The doctors at the second hospital said they weren't sure what they would find and they were a little surprised to find the abscesses. Chris is in good health, doesn't have any known risk factors and doesn't have a long history of stomach ailments. He does get constipation/stomach pains with a lot of stress, but he is generally healthy.

I don't know if you would consider the first doctor negligent. On one hand he did do several tests before he decided on the Hepatitis diagnosis. On the other hand he stopped short of doing the one test to properly diagnose the problem. Chris was in the worst pain I have ever seen that night, it was worse than when his appendix ruptured. From what his new team of doctors has told us, there is no reason to believe this will have long term effects on him. There is chance it is caused by Crohn's disease, but that isn't anything the ER doctor could diagnose himself.

I honestly can accept the $400 bill, it stinks but it is the way it goes. Right now I think filing a complaint may be the right avenue. Personally, I don't want to sue the doctor because it is really without merit. I just don't want to pay the bill without first saying I am not happy with the quality of care.

Hi Amanda,

If you have health insurance that company may be your ally in correcting the bills from the ER room since there was a misdiagnosis. I would contact your insurance company - no one knows how to avoid making medical payments like a medical insurance company does.

If/when you do contact the hospital adminsitrator/billing, do it in writing or at least by e-mail. Start a paper trail. That way if things get long and drawn out you have proof that you weren't just "not paying" the bill but were legitimately protesting your obligation to pay it.

I don't know how to say this delicately. Most ER docs are very wonderful, trustworthy physicians who are dedicated to providing the best medical care on earth. However, there are some physicians who run into trouble in their career, don't seem quite able to make it in private practice or at a teaching hospital, but somehow end up in an ER. You might ask the hospital adminsitrator about that specific ER doc's qualifications, how long he's been at the hospital, etc., whether or not this doctor has had trouble with these types of diagnosis. Just let them know that $400 is a lot of money to you and you can't afford to pay for medical mistakes. That's a long way from threatening legal action but hopefully will get you what you want which is relief from the bill.

I'm glad that your husband has finally received proper med treatment. I know my son has seen more than his fair share of ERs and fortunately we've had only the best ER docs. Butfor those very few docs who get thru the cracks, not good.

I assume the charge was more then $400, and you are using $400 since that is your out of pocket, a $400 ER visit would be on the very low side. Plus I doubt the Doc's bill was over $125, the rest would hospital/ER charges. Often there is a process of looking at certain things first, it doesn't sound like anything was not done correctly, but maybe the Doc could have gone down a better path to discover what was wrong. Anyway, all is well that ends well, I guess. You can talk to the Admin, but your insurer is maybe a better choice.

I saw my thread rise to the top so I will fill everyone in on our current situation.

Yesterday my husband was officially diagnosed with Crohn's disease. The stomach pain that landed him in the ER was his first flared up and honestly I think it could have been much worse if our family practice doctor hadn't told us not to wait on the Hepatitis test results. He is not receiving therapy for Crohn's and finally feeling better. We hope he has avoided stomach surgery, but at this point it is still possible. They are trying to start him on Remicade tomorrow.

The portion we owe the doctor after insurance is $250. I have contested the bill with his group and am waiting a review by their physcians panel. The other $157 I am comfortable paying to the hospital. The hospital did some X-rays and the Ultrasound, which the second hospital did not need to do again. It shortened the time needed to find out what was going on when we ended up back at the hospital. One way or another we would have paid for those tests.

I felt it was right to appeal this bill. I do not think this doctor should get our hard earned money. There is no reason in my opinion not to request the CT scan since his liver count was 1/10 of what the doctor himself said he normally sees with Hepatitis. He went with Hepatitis because it was 2:00 am on a Friday, he had a Hepatitis case the week before and he was confused. Why not call the GI doctor on call that night for a consult? The pain my husband endured for 3 additional days was not acceptable.

I just wanted to say if anyone ever has this problem- file an appeal/complaint! We just received word today that the doctor's group approved our appeal and waived the $250 we owed the emergency room physcian. The hospital billed us $157 separately, which we paid. It gave my DH and I great satisfaction not to be out of pocket for a doctor who completely misdiagnosed him.

In the end my husband's hospital bills cost us $1000 out of pocket, instead of $1250. It is a small amount, but it makes us very pleased.

Amanda - great news!! Hey $250 can buy some nice cycling clothes!

I'm still waiting on a $2,500 appeal on my surgery one year ago. My spine doc ordered a machine that continually tested my nerves during surgery to make sure everything was OK. The insurance company said it wasn't medically necessary. My doc wrote a letter & we're still waiting for the insurance company to make a decision.

Health care shouldn't be this big of a hassle! It feels like "us" against "them".

glad that your daughter is "safe" from misdiagnosis.

By the way, would suggest you start a different topic thread since the original thread and discussion was back..in 2006.