A&E attendance charge - no service provided

noStars

I'm wondering if anyone can help me with the legal position on the following:

I recently was brought to the Emergency Dept of a public hospital by ambulance after being kicked in the head by a horse. I hadn't lost consciousness but my head was bleeding severely and I had fallen on my fingers, two of which the EMT suspected were dislocated and possibly broken. The EMT put a large temporary bandage around my head (since he wasn't sure exactly where the lac was and didn't want to go poking around at it) and took my BP and pulse. When he brought me to the hospital I was put on a trolley and after a few failed attempts to find a monitor that worked, a nurse took my BP and pulse again. She didn't examine either my head or hand, asked me if I was allergic to anything and said she'd be right back with something for the pain. An hour an a half later, a different nurse appeared with 2 solpadeine and 2 ibuprofen tablets. After another hour and a half and still no sign of even a cursory examination, I rang a friend to come get me and told the person at the desk that I was leaving. The only response I got was "ok", no questions, didn't have to sign anything to acknowledge that I was leaving. My friend collected me and brought me closer to home (I was ~2 hours from home) and I went to the A&E at the nearest hospital to home. I explained that it was about 6 hours since the accident and that my head was still bleeding and was examined pretty much straight away. I ended up with 6 staples in my head (lac was too deep for stitches apparently) and after a serious of x-rays they're still not sure if my hand is broken as the swelling hasn't gone down yet.

I got a 100 euro bill from my local A&E which I paid straight away, they provided a brilliant service. Then a couple of days later I got a bill from the first A&E. I don't think I should have to pay the first A&E since none of my injuries were even examined, let alone treated. What is the legal position on this? From my perspective, no service was provided so why should I be expected to pay?

PucaMama

noStars wrote: »

I'm wondering if anyone can help me with the legal position on the following:

I recently was brought to the Emergency Dept of a public hospital by ambulance after being kicked in the head by a horse. I hadn't lost consciousness but my head was bleeding severely and I had fallen on my fingers, two of which the EMT suspected were dislocated and possibly broken. The EMT put a large temporary bandage around my head (since he wasn't sure exactly where the lac was and didn't want to go poking around at it) and took my BP and pulse. When he brought me to the hospital I was put on a trolley and after a few failed attempts to find a monitor that worked, a nurse took my BP and pulse again. She didn't examine either my head or hand, asked me if I was allergic to anything and said she'd be right back with something for the pain. An hour an a half later, a different nurse appeared with 2 solpadeine and 2 ibuprofen tablets. After another hour and a half and still no sign of even a cursory examination, I rang a friend to come get me and told the person at the desk that I was leaving. The only response I got was "ok", no questions, didn't have to sign anything to acknowledge that I was leaving. My friend collected me and brought me closer to home (I was ~2 hours from home) and I went to the A&E at the nearest hospital to home. I explained that it was about 6 hours since the accident and that my head was still bleeding and was examined pretty much straight away. I ended up with 6 staples in my head (lac was too deep for stitches apparently) and after a serious of x-rays they're still not sure if my hand is broken as the swelling hasn't gone down yet.

I got a 100 euro bill from my local A&E which I paid straight away, they provided a brilliant service. Then a couple of days later I got a bill from the first A&E. I don't think I should have to pay the first A&E since none of my injuries were even examined, let alone treated. What is the legal position on this? From my perspective, no service was provided so why should I be expected to pay?

are you sure you signed nothing? its a basic hospital procedure. theres always some patient unhappy they have to wait.

noStars

PucaMama wrote: »

are you sure you signed nothing? its a basic hospital procedure. theres always some patient unhappy they have to wait.

No, definitely signed nothing. Wouldn't have been able to sign anything properly anyway - that was the hand that was injured.

Marcusm

noStars wrote: »

No, definitely signed nothing. Wouldn't have been able to sign anything properly anyway - that was the hand that was injured.

Write to the first hospital enclosing a copy of the bill you paid in the second hospital. I suspect you'll hear nothing further.

noStars

Marcusm wrote: »

Write to the first hospital enclosing a copy of the bill you paid in the second hospital. I suspect you'll hear nothing further.

Didn't think of that, might give it a go, thanks!

I was wondering what the legal position is though - are they allowed to just send out bills without even examining me?

MarkAnthony

noStars wrote: »

Didn't think of that, might give it a go, thanks!

I was wondering what the legal position is though - are they allowed to just send out bills without even examining me?

There was an ambulance, two nurses and the administration of medication. I'd say they've a right to bill. One hospital might have hundreds of people who triage have decided need to be seen before you, another might have none. On any given day the situation might be reversed.

D Trent

noStars wrote: »

I'm wondering if anyone can help me with the legal position on the following:

I recently was brought to the Emergency Dept of a public hospital by ambulance after being kicked in the head by a horse. I hadn't lost consciousness but my head was bleeding severely and I had fallen on my fingers, two of which the EMT suspected were dislocated and possibly broken. The EMT put a large temporary bandage around my head (since he wasn't sure exactly where the lac was and didn't want to go poking around at it) and took my BP and pulse. When he brought me to the hospital I was put on a trolley and after a few failed attempts to find a monitor that worked, a nurse took my BP and pulse again. She didn't examine either my head or hand, asked me if I was allergic to anything and said she'd be right back with something for the pain. An hour an a half later, a different nurse appeared with 2 solpadeine and 2 ibuprofen tablets. After another hour and a half and still no sign of even a cursory examination, I rang a friend to come get me and told the person at the desk that I was leaving. The only response I got was "ok", no questions, didn't have to sign anything to acknowledge that I was leaving. My friend collected me and brought me closer to home (I was ~2 hours from home) and I went to the A&E at the nearest hospital to home. I explained that it was about 6 hours since the accident and that my head was still bleeding and was examined pretty much straight away. I ended up with 6 staples in my head (lac was too deep for stitches apparently) and after a serious of x-rays they're still not sure if my hand is broken as the swelling hasn't gone down yet.

I got a 100 euro bill from my local A&E which I paid straight away, they provided a brilliant service. Then a couple of days later I got a bill from the first A&E. I don't think I should have to pay the first A&E since none of my injuries were even examined, let alone treated. What is the legal position on this? From my perspective, no service was provided so why should I be expected to pay?

When you were brought by ambulance was it a voluntary ambulance or public national ambulance?

noStars

D Trent wrote: »

When you were brought by ambulance was it a voluntary ambulance or public national ambulance?

I'm not sure, the equestrian centre where I was rang for the ambulance. I think it looked like national ambulance uniform that the emt had on though.

I'd happily pay a bill for the ambulance if they sent me one - they did their job!

Dozen Wicked Words

noStars wrote: »

I'm not sure, the equestrian centre where I was rang for the ambulance. I think it looked like national ambulance uniform that the emt had on though.

I'd happily pay a bill for the ambulance if they sent me one - they did their job!

Ambulance, if you paid for it, would be considerably more than 100 euro.

D Trent

noStars wrote: »

I'm not sure, the equestrian centre where I was rang for the ambulance. I think it looked like national ambulance uniform that the emt had on though.

I'd happily pay a bill for the ambulance if they sent me one - they did their job!

Well if the equestrian centre had to ring for an ambo then it was the public NAS one that you were brought in and that would be included in the bill from first emergency dept.

Btw they are Paramedics, one level above EMT

noStars

Dozen Wicked Words wrote: »

Ambulance, if you paid for it, would be considerably more than 100 euro.

I'd imagine it would be, and I'd find some way to pay whatever amount it was if my health insurance didn't cover it. I don't have an issue with paying the amount of the money on the bill, I have an issue with being asked to pay for a service that wasn't provided.

noStars

D Trent wrote: »

Well if the equestrian centre had to ring for an ambo then it was the public NAS one that you were brought in and that would be included in the bill from first emergency dept.

Btw they are Paramedics, one level above EMT

Re: paramedics - my apologies, didn't know there was a difference. I'll know for again, thanks.

Re: the bill - it's just for 100 euro, which the the standard Emergency dept charge that I paid to the hospital that treated me. There's no mention of the ambulance on the bill.

Dozen Wicked Words

noStars wrote: »

I'd imagine it would be, and I'd find some way to pay whatever amount it was if my health insurance didn't cover it. I don't have an issue with paying the amount of the money on the bill, I have an issue with being asked to pay for a service that wasn't provided.

I suppose they consider it the start of their service when your details are put in the system and that you leaving early didn't allow them to finish their service. Not saying they are right, just my best guess. They should have got you to sign a self discharge form to cover themselves if nothing else though. Good luck anyway, and I'm glad you're OK.

Traumadoc

There is a 100 euro charge if you register at an A+E , it was introduced to try to get people to go to their GP first, If you have a GP letter not charge.

You took up clerical staff and nursing staff time, you were provided with medication. A chart would have been made up.

Why don't you go to the cinema, then leave after 20 mins ant try to get your money back then see what happens.

As for the laceration being too deep for stitches, and having staples instead?

:rolleyes::rolleyes::rolleyes:

we use staples because it is quicker and easier to remove following healing.

PucaMama

Dozen Wicked Words wrote: »

I suppose they consider it the start of their service when your details are put in the system and that you leaving early didn't allow them to finish their service. Not saying they are right, just my best guess. They should have got you to sign a self discharge form to cover themselves if nothing else though. Good luck anyway, and I'm glad you're OK.

but they are right. he wasnt left with no treatment. they done what they could at the time. noone forced the op to leave. ive seen both sides of it. ive been the patient too.

i also find it very hard to believe he didnt sign anything.

Dozen Wicked Words

PucaMama wrote: »

but they are right. he wasnt left with no treatment. they done what they could at the time. noone forced the op to leave. ive seen both sides of it. ive been the patient too.

i also find it very hard to believe he didnt sign anything.

Wasn't saying they were wrong either, I have no idea about legal side of things, so I was sitting comfortably on the fence!

noStars

PucaMama wrote: »

but they are right. he wasnt left with no treatment. they done what they could at the time. noone forced the op to leave. ive seen both sides of it. ive been the patient too.

i also find it very hard to believe he didnt sign anything.

As I said above, I didn't sign anything. I wasn't asked to sign anything. I didn't just walk out the door, I went and told them at the desk that I was leaving. I expected that legally I'd have to sign something but it wasn't brought up by any of the 3 people behind the desk.

I don't consider have my blood pressure checked or being given solpadeine/ibuprofen "treatment" for being kicked in the head by a horse, it's a very basic triage assessment. They didn't attempt to examine me at any stage.

noStars

Traumadoc wrote: »

There is a 100 euro charge if you register at an A+E , it was introduced to try to get people to go to their GP first, If you have a GP letter not charge.

You took up clerical staff and nursing staff time, you were provided with medication. A chart would have been made up.

Why don't you go to the cinema, then leave after 20 mins ant try to get your money back then see what happens.

As for the laceration being too deep for stitches, and having staples instead?

:rolleyes::rolleyes::rolleyes:

we use staples because it is quicker and easier to remove following healing.

I said that was the apparent reason in my original post, as that's what I was told by the doctor who actually examined me. I'm obviously not a physician so I can only rely on the information I'm given by those that are.

If I went to the cinema for 20 minutes, I might have at least seen a fraction of the film. So silly of me to think that the purpose of a hospital was to treat people, not condescend to them.

PucaMama

noStars wrote: »

As I said above, I didn't sign anything. I wasn't asked to sign anything. I didn't just walk out the door, I went and told them at the desk that I was leaving. I expected that legally I'd have to sign something but it wasn't brought up by any of the 3 people behind the desk.

I don't consider have my blood pressure checked or being given solpadeine/ibuprofen "treatment" for being kicked in the head by a horse, it's a very basic triage assessment. They didn't attempt to examine me at any stage.

what exactly do you expect them to do? as you said its basic triage. you didnt wait for the doctor. they didnt refuse you you left.

gozunda

noStars wrote: »

...

I got a 100 euro bill from my local A&E which I paid straight away, they provided a brilliant service. Then a couple of days later I got a bill from the first A&E. I don't think I should have to pay the first A&E since none of my injuries were even examined, let alone treated. What is the legal position on this? From my perspective, no service was provided so why should I be expected to pay?

It is unfortunate that many of the countries hospitals continue to have horrendous wait times for A&E treatment.

I would recommend that in instances like this where there was no loss of consciousness etc to attend your GP - who following an examination, supply a letter for A&E whereby you 'may' be seen more quickly and also forgo the A&E charge.

Most A&E dept of hospitals are understaffed and oversubscribed and long wait times even for serious conditions are fairly common. As you probably know treatment is generally provided on assessed need following triage - this is from one of the national hospitals

3. Triage:

Following check-in you will be seen and assessed by the triage nurse who will take a full history and assign a triage category. Triage means that patients are prioritised according to the urgency of their condition.

You will be seen according to your clinical priority and not your time of arrival.
Waiting times will vary from day to day, hour to hour, depending on the workload and staff levels.

Patients checked in after you may be treated before you depending on their clinical need and triage category.

I believe your best bet would be to write a letter outlining your issues with the treatment / lack of treatment you received at the first hospital. State clearly that you were left with no option but to leave and that you attended and were seen quickly at another hospital. Clearly lay out why believe why you should not be charged.

Glad to hear your ok after the head kick btw.

kilp10

You were brought in because you probably needed to be brought in. The Paramedics would have registered you when you were brought in so yes, you would be liable for the A&E charge at Hospital 1 (once you're registered). A patient won't necessarily sign anything if they're brought in and released on the same day, it's only if you're being kept in and insurance needs to kick in etc. They deal with people walking out because they can't stand to wait all the time.

You chose to leave by your own free will as other patients were prioritised ahead of you. You decided to attend another hospital which just happened to probably be having a quieter night. Legally, I don't have a clue, but seeing as you decided to leave before being examined then yes, I reckon you would be expected to pay both A&E charges. You might get away with producing the receipt from Hospital B to Hospital A but I'll be surprised if they still don't ask for payment seeing as you left voluntarily.

Waiting is a pain but the A&E staff in many hospitals are overrun and trying to work with very little resources for the number of patients. Saying that, they really are brilliant when you need them.

tiny_penguin

I don't know the legal standpoint but from personal experience my boyfriend has attended A&E twice in the past 2 years. The first time was on a sat night/sun morning. He paid the €100 up front and went into triage. After an hour and a half waiting he we should go home and come back the next day. He had to wait in the queue again the next day but they didn't charge him again as he had already paid the night before.

Last week he was in on a Monday night. Again paid €100 up front and was told after Triage there would be roughly a 12 hour wait. He spoke to the receptions who obviously said they recommended he wait but if he wanted to go home that was his choice, if when he came back he hadnt missed his call he would keep his place in the queue. If he had missed the call he may have another 12 hour wait on his hands but no further charge and if he chose not to come back he would be refunded the €100 as he just went through triage and wasn't treated.

Traumadoc

noStars wrote: »

I said that was the apparent reason in my original post, as that's what I was told by the doctor who actually examined me. I'm obviously not a physician so I can only rely on the information I'm given by those that are.

If I went to the cinema for 20 minutes, I might have at least seen a fraction of the film. So silly of me to think that the purpose of a hospital was to treat people, not condescend to them.

the €100 charge is a fee for attending the A&E, it is there to encourage people to see their GP first. It is not a fee for treatment.

Cushie Butterfield

Traumadoc wrote: »

the €100 charge is a fee for attending the A&E, it is there to encourage people to see their GP first. It is not a fee for treatment.

The €100 Statutory A&E charge is only payable if the patient is seen by a doctor or a nurse practitioner. the charge is not for triage, clerical staff, electricity or anything else. All patients are registered on the hospital system no matter what way they arrive, which (depending on if they are chargeable or not e.g medical card holders & patients with a gp referral letter are not charged) generates a bill either there or then or at a later stage by the hospital billing dept depending on their particular computer/billing system.

Many people don't wait to be seen (formally treated) & if they are not 'logged out' as a DNW (did not wait) properly on the system by clerical staff (happens quite regularly during busy periods or staff shift changeovers) an invoice will automatically at some stage be raised. Similary if someone has a GP referral letter & that isn't recorded on the system an invoice will automatically be generated.

Being initially assessed by a triage nurse & leaving before being attended to by is not chargeable. A triage nurse wouldn't have been able to give you ibuprofen, solpadeine or any other medication without being authorised by a doctor or a nurse practitioner.

However, in this case it sounds as if the 'second nurse' was actually a nurse practitioner. Normally if someone gets a bill that hasn't been seen & ring the billing dept of the hospital & say that they weren't seen by a doctor or nurse practitioner, depending on the limited information that they have access to on the computer system they would either cancel the invoice & if already paid arrange a refund, or contact the A&E dept clerical staff who can check the patient's card & confirm to them whether or not the patient was seen.

Normally if you have paid an A&E charge in a hospital & return within a reasonable amount of time with the 'same complaint' you should not be charged. But seeing that OP actually presented at another A&E it would more than likely be at the discretion of the second hospital whether or not they would cancel the bill, as it was a completely different hospital & OP wasn't referred there by the other A&E or your GP.