To the Editor:
Kyla had just turned 18 when I met her and her dad on their sixth day in the hospital. I was a freshly minted third-year medical student. Kyla, on the other hand, was an old pro, admitted numerous times for severe flares of Crohn’s disease.
As the end of Kyla’s 2-week steroid course neared, our case manager discovered she had been dropped from her dad’s insurance plan, and her application for Medicaid was still pending. It was not long before the hospital’s financial team arrived at Kyla’s room to deliver the news and insist she sign a contract stating she would pay over $150,000 if the issue was not resolved. Further, it was unclear if she would be able to get the new medication that we wanted to try which cost $4,000 per month.
Holding his tearful daughter, Kyla’s dad grasped for understanding, “Why didn’t anyone tell us this was happening?” It did not matter. Kyla, 18 years old and unequivocally in need of hospital care, had no choice but to sign on the line.
It was the first time in my training I saw a hospital’s commitment to collecting bills infringe on patient care. For the past week, my job had been to answer questions, sit with uncertainty, and cultivate hope for Kyla and her dad, but now I felt powerless and ill-equipped. How could I help my patient navigate the distress of worrying about devastating financial loss from her hospital bed?
But in truth, it was just another day in the hospital. A recent study estimated over 1,400 families declare bankruptcy from medical-related costs every day.1 For me, though, this “first” represented the start of my participation in delivering health care that is contingent on ability to pay. It showed me that without disrupting the status quo, insurance companies, pharmaceutical corporations, and hospital systems will dictate how I am allowed to apply the skills I am learning in medical school.
What happened to Kyla, and to so many others in need of treatment, should bother us deeply. I hope I will never stop feeling that. And that it will continue to motivate me, my classmates, and the physicians who came before us to join other health care workers in organizing and advocating with unparalleled conviction against the industries profiting from making medical care painfully expensive and stressful for our patients.
Hannah M. Borowsky
Third-year medical student, University of California, San Francisco, School of Medicine, San Francisco, California; [email protected]
Reference
1. Himmelstein DU, Lawless RM, Thorne D, Foohey P, Woolhandler S. Medical bankruptcy: Still common despite the Affordable Care Act. Am J Public Health. 2019;109:431–433.
