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Stories from the trenches: patients who cannot afford their basic meds and end up hospitalized.

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Case #1. COPD exacerbation.

Subjective:

68 year old female with past medical history of severe COPD, not on any home medications, presents with shortness of breath and cough. She is admitted for COPD exacerbation and acute hypoxic respiratory failure.

She has not been on any inhalers, not even albuterol, because she and her husband cannot afford to pay any copays.

Objective:
Oxygen saturation 84% on room air, 91% on 2L Oxygen.

Lungs are tight, poor air movement, diffuse wheezing, mild crackles.

Assessment:
1. Acutely worsened COPD due to medication non-compliance (unable to afford).

2. America’s healthcare system sucks, and people are suffering! Insurance companies are leaches upon the lives of the American people. They are useless and superfluous to the delivery of healthcare. Healthcare is a social service, and it should be paid for by society for the good of society.

Plan:

1. Stabilize patient with nebulizer treatments every 2 hours, until they can be spaced out to 6 hours. Continue on 2L oxygen, and wean down to room air as tolerated and oxygen saturation is above 91%. Discharge on antibiotics, steroids, nebulizers (doh, she can’t afford them. Consult social work to find a way to help patient with payments.)

2. Make the Democratic House grow a spine, and pass HR676. Even if the Senate doesn’t pass their version, it will be a strong signal to the American people that Democrats stand up for their values, and will protect the lives of the American people, not the pockets of insurance companies.

Case #2: Heart failure exacerbation

Subjective:

47 year old male construction worker with past medical history of poorly controlled diabetes (on metformin and insulin; recent A1c 10.2%) , hypertension (on triple therapy), coronary artery disease (MI 2 years ago, 2 stents placed), heart failure (last ECHO with ejection fraction 35%) presents with shortness of breath, cough, leg swelling, reduced exercise tolerance, fatigue. He is admitted for heart failure exacerbation.

He has not been taking any of his medications for 2 months, because he can’t afford them. He lost his job and his insurance. He is married and has two daughters (6 year old and 8 year old). His wife is disabled with sever MS.

Objective:

BP: 186/102. HR: 88. RR 24.

Sodium: 130, BNP 1500, chest xray: pulmonary edema.

Lungs have diffuse crackles. Heart sounds include S3. Bilateral 3+ lower leg edema up to the thighs

Assessment:

1. Heart failure exacerbation secondary to medication non-compliance (loss of job and insurance)

2. Citizens of the richest country in the world should not live with fear and anxiety and be 1 pay check away from catastrophic illness that could send their kids out onto the street! The majority of Americans support a single-payer healthcare system.

3. Insurance companies are evil SOBs!

Plan:
1. Lasix 80mg IV BID until patient is euvolemic, then switch to PO. Put patient back on heart failure, diabetes, and antihypertensive medications and send him home with those on discharge (doh, he can’t afford them. Consult social work for assistance.)

2. Make the Democratic House grow a spine, and pass HR676. Even if the Senate doesn’t pass their version, it will be a strong signal to the American people that Democrats stand up for their values, and will protect the lives of the American people, not the pockets of insurance companies.

Case #3: Hyponatremia, Syncope

Subjective:

87 year old female with past medical history of dimentia presents after a ground level fall at home. She is admitted for acute encephalopathy and severe hyponatremia.

She lives at home by herself. Her daughter is her only family in town. The daughter works 2 full time jobs and can’t visit her mom more than 2 times a week. Patient has not eaten anything other than “tea and toast” for 4 days. Daughter can’t afford to put mom in nursing facility, and their insurance doesn’t pay for it either.

Objective:
BP: 100/76. Sodium 116. Alert, oriented to self. Thin, frail, weak. Neuro exam otherwise normal.

Assessment:

1. Adult failure to thrive

2. severe hyponatremia secondary to poor oral intake

3. A corrupt and morally bankrupt society that leaves its elderly exposed and vulnerable, and their children unable to take care of them due to constant struggle to make ends meet and lack of social support secondary to an uncaring and callous society that is conditioned not to care about its own people.

Plan:

1. IV fluids to bring up sodium level gradually over 48 to 72 hours.

2. Consult social work to assist family with resources.

3. Make the Democratic House grow a spine, and pass HR676. Even if the Senate doesn’t pass their version, it will be a strong signal to the American people that Democrats stand up for their values, and will protect the lives of the American people, not the pockets of insurance companies.

Alexandria Endorses:

Improved and Expanded Medicare for All Act (H.R. 676)

Share your own stories of how evil insurance companies put you and your family’s health in danger:


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