Just Take some Tylenol, Doctors Said - And Then After More Neglect The Patient Died

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" Just Take some Tylenol, " Doctors Said - And Then

After More Neglect The Patient Died

 

http://www.iht.com/articles/531123.html

 

Korean's U.S. trip ends in death, and anger

Marc Santora NYT

Monday, July 26, 2004

 

NEW YORK Moon Chul Sun's head was throbbing, so

painful it was a struggle to stand.

 

For three days, after being taken to the emergency

room at the Jamaica Hospital Medical Center because of

a soccer injury, Moon, a South Korean here on a

tourist visa, barely moved from his hospital bed,

largely unable to communicate with the doctors and

staff because he spoke no English.

 

He just waited.

 

His wife pleaded in Korean with people at two

different hospitals who often did not fully understand

what she was saying, begging for someone to ease her

husband's pain or at least explain to her the mystery

of his illness.

 

After 72 hours of fractured conversations and a series

of medical tests, an interpreter arrived to tell

Moon's wife that her husband was being discharged.

 

" They said, 'Just take some Tylenol,' " Moon's wife

said.

 

One month and several confounding hospital visits

later, Moon was dead, and his wife says she was told

that the cause was an injury to his head.

 

In the arc of his 34-day journey through the medical

world, Moon struggled to understand his options even

as what ailed him remained a mystery to his family

because of communication problems.

 

There were confusing conversations about insurance and

a staggering bill that left his family reeling. There

was the option to apply for Medicaid, the government

program for people who cannot afford care. That was

declined by the hard-working family, a decision fueled

in part by pride, fear and a lack of information.

There would be friends and neighbors drawn into the

story, brought along to try and help the family

understand exactly what the medical professionals were

saying or concluding.

 

In the end, there would be death and anger.

 

The hospitals say they did everything they could for

Moon, performing many, tests, directing him to the

Medicaid program and even scheduling a follow-up

appointment that he did not keep. While unable to go

into specific details because of privacy concerns,

officials at the hospital system that treated him

suggested that Moon's original injury appeared not to

have been related to the cause of death.

 

But, as public health experts and even officials of

the hospitals that treated him acknowledge, Moon's

death illustrates the flaws in a health care system

that all too often can seem broken to those without

insurance - riddled with cracks and complications that

are compounded when cultural taboos and language

barriers are thrown into the mix.

 

For the most vulnerable, emergency rooms are the place

of first resort. At least there they are assured

treatment.

 

Once discharged, they often have no contact in the

medical community and become lost in a system that can

barely handle the problems on its doorstep looking to

come in, much less those already sent back outside.

 

Hospitals feel overwhelmed, and patients feel as if

they are treated not as people but as problems.

Confusion about coverage is the rule, and basic

communication is often imperfect.

 

And in New York, where the number of people with no

health insurance is nearing 27 percent, not including

undocumented immigrants, the problem is all the more

urgent, patients and practitioners say.

 

David Rosen, the president of MediSys Health Network,

which owns and operates three hospitals in New York

City, Jamaica, Flushing and Brookdale, said, " You have

a system that doesn't work. "

 

Congress, he said, has systematically sought to

eliminate a whole class of people from being eligible

for assistance.

 

Yet, he said, his hospitals provide a standard of care

that is top-notch regardless of the patients' ability

to pay.

 

Still, he added, the health care system has largely

" written these people off. "

 

Moon's wife, 44, who asked that her name not be used

because she feared public exposure could cause her

children trouble, told the story of her husband while

sitting on the floor of the family's one-bedroom

apartment in Flushing, a neighborhood in the New York

City borough of Queens that has long been a magnet for

Asian immigrants.

 

As she held her head in her hand, wiping away frequent

tears, she related the details of her husband's

hospital treatments. Her sister-in-law, Young Sook

Kim, who traveled to America to attend Moon's funeral,

sat next to her and picked up the story when Moon's

wife became too emotional to continue. Both women

spoke through an interpreter.

 

Moon arrived in the United States 10 months ago, after

having saved enough money to try to gain a foothold in

this country. A skilled carpenter in South Korea, he

came with the aim of eventually gaining a green card

because he wanted his children to be educated here.

 

After staying with a relative in Boston, Moon moved to

Queens, where he felt that given the borough's large

Korean community, he could communicate and find decent

work. There are some 62,000 Koreans in Queens. After

six months, Moon's wife, two daughters - 15 and 13 -

and 12-year-old son joined him.

 

" He was happy because he found this place good for his

children, " Kim said. " He was healthy, very strong and

he played soccer every day. "

 

On Sunday, June 6, at 6:30 a.m., Moon went over to the

local high school to sign up for the summer league and

play in a match. During the game he got sick, said his

wife. He returned home early, around 9 a.m.,

complaining of a headache. He thought it might have

been the result of a being hit hard in the head by the

ball, his wife said.

 

By midnight the headache had not gone away, and Moon's

wife called for an ambulance. He was taken to Flushing

Hospital Medical Center. He was given a CAT scan,

Moon's wife said, and an interpreter said that it

showed a blood build-up in a vein in his brain.

 

Hospital workers told the couple that Moon would have

to be taken to Jamaica Hospital, because it had

specialists trained to handle such cases, Moon's wife

said. There, workers gave Moon another CAT scan,

according to his wife, and told him to wait 72 hours.

Moon's wife said he was discharged on June 9, with the

sole instruction, as the couple understood it, to take

Tylenol.

 

Before they left, Moon's wife said, hospital workers

asked if they had insurance, and she replied that the

family had none.

 

" He was still sick, " Moon's wife said.

 

She said that the interpreter at the hospital spoke

little Korean and that they left confused. Workers

there told them to return to the hospital in 10 days,

his wife said.

 

Dr. Jam Ghajar, the chief of neurosurgery at Jamaica

and who works at the other MediSys hospitals, says

that head trauma is the leading cause of death among

young people - roughly two million cases are treated

annually - and that discharging a patient whose CAT

scan shows that bleeding has stopped is standard.

 

But the problem for Moon, and thousands of other

uninsured patients like him, is that while it is

against state law not to treat patients who show up in

the emergency room, once discharged, these patients

enter a much murkier world, where follow-up treatment

is often inadequately discussed.

 

" The experience is daunting and complex, " said Adam

Gurvitch, the director of Health Advocacy, a group for

the uninsured. " Fortunately, we hear few stories that

end in death. "

 

Moon and his wife returned to Jamaica Hospital on June

18, but this time he did not go to the emergency room.

He was still suffering severe headaches and spending

most of his time on his couch at home, and his wife

said that workers there told him that he had to pay

$95, or E78, to see a doctor. After paying the money,

Moon's wife said, a doctor told the couple that tests

could not be run that day, and that they should come

back on June 21.

 

On the appointed day Moon showed up, accompanied by

his wife and a neighbor who spoke English.

 

Moon's wife said that hospital workers told them that

a CAT scan would cost $552 and that they would have to

pay at least half of the cost to have the test. They

paid, the test was completed and the couple and their

neighbor went home to wait for the results. Moon and

his wife returned to the hospital a few days later,

this time with their eldest daughter, who spoke a

little English. The hospital said they had to pay $95

to see the doctor again, and told them for the first

time that they owed $4,500 for Moon's previous

hospitalization, Moon's wife said. They could not pay.

 

Moon's wife said they never got to meet with a doctor

again.

 

Rosen, the MediSys president, could not explain what

happened in this case, citing patient privacy laws,

but said that hospitals officials had reviewed the

case and were confident that they had done everything

right. He added that his hospitals never refuse to

treat patients, even those who cannot pay. He said

that there might have been a communication problem,

because there had been an appointment for Moon to meet

with a doctor on June 30, an appointment he missed.

Rosen also said that the follow-up CAT scan on June 21

showed no new problems.

 

But Moon's wife said that no one had shared that

result with her.

 

She said that the couple had set about trying to make

sense of their payment options. They were told they

could apply for Medicaid, but hesitated. " It means

being poor, " Moon's wife said. " We did not want our

children to grow up with that stigma. "

 

She also said she worried that if the family took the

assistance, their children's chances of getting green

cards would be jeopardized. When they asked a woman

working in the Medicaid office for guidance, according

to Moon's wife, she replied, " It may or it may not. "

 

In Moon's case, a medical emergency, it would not have

made a difference, according to immigration lawyers.

 

Immigrant families entertain such fears all too often,

according to Dr. Bruce Vladeck, a professor of health

policy at Mount Sinai School of Medicine.

 

Moon and his wife decided to try and pay off the debt

on their own.

 

For days, Moon's headaches continued, and the hospital

did not contact him, his wife said. On July 6, Moon

decided to get off the couch and go help a friend work

on a kitchen.

 

While there, he became violently ill, an ambulance was

called and he was taken once again to Flushing

Hospital.

 

Tests this time showed that there was blood in his

brain that had clotted, his wife said. He would need

emergency surgery.

 

He was transferred to Brookdale University Hospital

and Medical Center. Two operations later, he was dead.

 

Moon's wife said that the doctor, whose name she could

not recall, asked, " Why didn't you bring him in

sooner? "

 

She is now trying to make sense of it all.

 

With her three children and a $1,200 monthly rent

payment to make, she said she did not know how much

longer she could stay in New York but she needed

answers.

 

She recalled the last words of her husband, as they

rushed to the third and final hospital he would visit.

 

" He said, 'I don't understand,' " she recalled. " I

don't understand why I am sick like this. I can't be

sick like this. "

 

The New York Times