Lengthy memo shows medical system complexities

Nation's health woes multiplied behind bars

Waco – A brief discussion and a lengthy memo from the County Jail's director of nursing show a razor sharp picture of the knotty problems facing the nation's health care providers.

Who pays? How much? Comes down to the same hassle every time.

On June 14, a man from out of town got into some kind of dispute that led to his arrest during a visit to his family in this city.

A Veterans Affairs patient, he is in the final stages of renal failure and requires kidney dialysis treatment three times per week.

When the McLennan County Jail's medical care staff examined him, they discovered that the catheter used to provide the treatment was infected. He needed hospitalization, so the Sheriff's Office sent him to Providence Medical Center where deputies have been guarding him around the clock since June 16.

Until this week, he has been in no condition to leave the hospital and come back to the jail so he can make the trip to the courthouse to see the judge.

As straightforward as all this may be, it's here where the problem becomes complicated.

The VA has been providing his kidney dialysis, but at another medical center in another location. That organization will not provide payment or treatment because he is not a local patient of the system.

In any case, according to Director of Nursing Desera Roberts, R.N., “Steve Hernandez, County Veterans Services Officer, has spoken at length with the VA and they refuse to reimburse the dialysis clinic since the inmate is in a jail facility.”

How much does it cost, and does the County have a budget for $300 treatments, three times a week, at a cost of $3,600 per month – for as long as the patient is locked up in McLennann County?

In a word, the answer is yes - and no.

According to County Judge Jim Lewis, there is a budget item for outside medical care.

But, says Nurse Roberts, “I have found the County has NEVER paid a bill for any dialysis treatment for its inmates.”

How could that be?

“Medicaid and Medicare, which is the coverage most of the inmates have, does not pay once the insured is incarcerated, much like the VA. Fensenius (sic) continues to bill Medicaid and Medicare as usual, therefore Medicaid and Medicare are unaware the insured is incarcerated and Fensenius continues to receive payment.”

As pragmatic as the day is long, Nurse Roberts summed up her written report to the Commissioners Court by saying a contract for $300 per treatments, though the price is much higher than the authorized amount Medicaid and Medicare pays, is nowhere as expensive as paying for hospital care and armed guards around the clock to keep an eye on the inmate while he is at Providence.

After lengthy negotiations, both Dr. Wells and Nurse Roberts concluded that Fresenius Medical Care will not agree to a lower cost, one more in line with the government's guidelines for impoverished patients. Neither the branch office, nor the corporate wheels at the parent company, Bio-Medical Applications of Texas, Inc., are satisfied with the promises of the nurse and the doctor that the County of McLennan will pay their price.

They demand a letter of agreement, signed, sealed and delivered, before the needle goes in.

Once the Court understood that the care provider won't negotiate, and the cost of hospital care is prohibitive, the members made haste to make a motion to have a contract written and signed immediately.

What with the complications of reimbursement for dialysis treatment at the rate paid by Medicaid and Medicare brought out in the memo, it is not difficult to understand why we of The Legendary had difficulty obtaining Nurse Roberts' memo, which was filed on July 9, though we had made a public information act request for documents on the sixth. 

C'est la vie.
Comme ci, comme ça.