Should You Pay for Your Care Even When There’s a Medical Error?

Health
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By Linda Adler

Learn more about Linda on NerdWallet’s Ask an Advisor

I’m always intrigued when I get this question—not because I have a pretty good professional answer (I do) but because I have such a strong personal connection to the question. Here’s why.

Story 1: My vacation in Paris was perfect until I started having severe abdominal pain in the middle of the night. By 3 a.m. I was literally crying. My husband rang the doctor (yes, they make house calls there 24 hours a day) who called an ambulance. I was treated, although the cause of the pain was a mystery, so I flew home to see my doctor. While making that appointment, the nurse asked about my current medications, and when I told her, there was a long silence. It turns out that my doctor had made a serious medication error. No wonder I was in pain.

Story 2: My daughter had an unfortunate bike accident and one of the fractures required a quick and routine surgical procedure. No big deal, until it was—within 24 hours she was in excruciating pain. Visits to urgent care and to the ER yielded nothing, and she toughed it out at home. Ten days later, at her follow-up visit, they discovered multiple blood clots, one so large that it was literally cutting off the circulation to her arm—all due to the surgeon nicking a major artery during the procedure. She was admitted to the hospital and then treated as an outpatient for months. Her arm, neck and shoulder will never be the same.

Here I was: a professional healthcare advocate who needed to do some serious advocating on my own behalf! Here’s how I applied my expertise to address the challenges.

First, and most important, I didn’t make any decisions right away. I needed to let the emotion of the experience dissipate until I could think clearly.  I know how hard it is not to speak out of anger, to not communicate from a place of victimization. But when we deal with this issue emotionally, we’re not always doing ourselves a favor, because we make mistakes. So I waited until I was sure I had some clarity.

Second, I got information. There are medical errors, and then there are medical errors that qualify as malpractice. If you’re in the latter category, it’s critical to have a lawyer on board who determines how to proceed. In both of my cases, we consulted attorneys who determined that neither of these situations met the criteria for malpractice. (Yes, that medical consent form you sign before surgery matters).

Third, we determined our bottom line. As in all good negotiations, it’s important to know what you’re willing to settle for and what you’re not, and then to work within those parameters.  It was important to come up with what we believed was fair: we weren’t out to get rich off of these mistakes; we simply wanted to be “made whole.”

Fourth, we played fair. We prepared letters that were direct, clear and concise, and we kept our tone even and business-like. We didn’t rant, we didn’t whine, we didn’t blame. We stated what we expected to come from our communication and we kept it at that.

So what were the results? In the first case, the award was fair. They paid me back for the hotel, my travel costs, my hospital costs and all my medical bills. As for my daughter? The other side’s attorneys came in with guns blazing, and denied any wrongdoing, even though they knew a malpractice suit would be hard for us to win. Thankfully, we had decent health insurance, and the out of pocket (expense) wasn’t terrible. So yes, we paid, even in the face of a medical error. In the end, that was a healthier decision, given the stress the continuing negotiation would have produced.

So when someone asks if they should pay their bill in light of a medical error, the best answer I can offer is “it depends.”  No two cases are alike, so what’s most important is getting the process right when figuring out the answer. I only hope my own personal example will help someone else; that kind of compensation is valuable, too.