For-profit hospitals were first invented by a man who, when faced with the wails and groans of people in pain and in need of medical attention, was only able to hear the sounds of a cash register opening. Since then, FPHs have flourished in the United States, trying to quite literally turn shit into gold, only here the shit might be infected with cholera or something. Maybe not exactly in Mary’s case because she used to work for a for-profit psychiatric hospital. Still, the experience has taught her a lot about running a medical facility as a profit-oriented business, like: Don’t. Just don’t. Here’s why:
4. For-Profit Hospitals Are Gigantic Penny-Pinchers
If for-profit hospitals had their way, you’d have to insert a coin into your pillow every 10 minutes to keep it from sprouting spikes. If it was legal, every look outside their window would cost you money. If they could get away with it, FPHs would charge you an air tax. In short, for-profit hospitals are all ran by that inn-keeper from Les Miserables. Mary elaborates:
“In nonprofits patients could have snacks if they were hungry. At the for-profit hospital, it was tightly regulated what the patients could eat and when. If they woke up hungry at 2 am it was literally ‘too bad.’ We were not to give out snacks or sodas (even tho it was that shitty cheap-ass Shasta stuff) … Many times staff would often get chided for giving out more than one pair of hospital booties. People were only to get one pair per hospitalization. At a regular hospital, you give the patients what they need (within reason) so if they soiled the booties, you gave them a new pair no fuss.”
But, to be fair, for-profit places do take all those savings and then pass them on to… themselves. You, on the other hand, might find yourself stuck with a bill that, according to one study, will probably be 3.4 times larger than at a regular, nonprofit hospital. Just remember that this isn’t personal. FPHs don’t really want your money. They just want your insurer’s money.
3. FPHs Might Keep You Longer Or Give You Unnecessary Meds Just To Milk Your Insurance
Determining the length of a patient’s hospital stay is a complicated process. You have to consider their needs, the needs of the hospital, your budget, your staffing situation etc. At for-profit hospitals, though, the main thing the administration asks themselves is: “how many insurance days do they have left?”
“The Doc tried to discharge someone when they still had ‘insurance days’ at the for-profit and the utilization review person was not happy at all. The doc later was made aware that they do not discharge someone with days still left … Doc had wanted to discharge a man with depression who was responding fantastically. He was ready for discharge, the nurses thought he was ready for discharge, the doc thought he was ready, social work thought he was ready but when Doc said she intended to let him go, U.R. interrupted ‘Uh, he’s still got two insurance days (covered days). You do not want the business office talking to you about discharging with insurance days left.’”
Essentially, if FPHs were retail stores, they’d answer questions like “How much does this cost” with “How much you got?” And then they’d try and sell you a lawnmower or something, whether you needed it or not. The lawnmower is code for unnecessary medication.
“We once had a patient who was responding well to a normal dose of Lexapro-10 mg. She was doing well in groups, but she didn’t feel like she was quite ready for discharge yet. Utilization Review stated that her insurance required meds to be changed/increased every 3 days to get more days covered. So the Doc prescribed Abilify 5 mg. ‘Abilify?’ I asked, ‘she isn’t having any psychosis.’ ‘Well, it’s indicated for refractory depression’ (it had not yet been approved by the FDA for this purpose).”
In short, please never ever visit a FPH that currently has a surplus of suppositories.
2. The Doctors’ And Nurses’ Opinions Don’t Mean Shit
A few years back, Mary’s hospital admitted a man who was incontinent even after the doctor said he wasn’t suited for their facility. “We were freestanding and the techs assumed that only nurses could assist the man with his toileting. They frequently tried to push any care off on a female staff member. We did not have the time or the correct skin care products to care for that man. He should have been at an actual hospital or a nursing home. I can’t quite remember, but he may have had dementia – something we certainly weren’t ready to treat. Acute inpatient is more geared towards treatable mental illnesses like bipolar, depression, schizophrenia… not dementia.”
So why did they take him in? Because the CEO of the hospital ordered it. In his defense, he probably couldn’t clearly see the man’s paperwork because of the huge dollar signs in his eyes.
“Another time the doc didn’t want to take someone who was MR (mentally retarded) as we weren’t really equipped to handle them and she was not comfortable treating them as you (in her words) ‘Can’t fix this with meds.’ The CEO overruled her as the client wasn’t ‘officially diagnosed’ and crisis said she was ‘high functioning.’ It was a nightmare. She was not high functioning. And lo and behold, she had no actual psychiatric issue … There was a patient who had deep lacerations to her bilateral Achilles’ – something we were absolutely unable to treat. She needed extensive wound care. She was accepted and then once it was shown just how bad the lacs were (she couldn’t walk) she was transferred.”
1. For-Profit Hospitals Can Be Dangerous
There comes a time when profit-making stops being merely dickish and starts to become dangerous. For example: all of capitalism everywhere. A more relevant example would probably be trying to cram so many people into your FPH that it makes a phone booth look downright spacious.
“They crowded up to 40 acutely mentally ill persons (some who were also substance abusers and actively detoxing) all in one ward. There was not near enough room for people to just pace about and get energy out. Everyone was very close to each other and the emotions would feed off each other very, very quickly.”
Also, there was no security at Mary’s hospital. If someone wanted to start a fight there was really no one who could stop that. This, naturally, also lead to attacks on the staff.
“We had a patient charge a staff member with a guitar. A patient jumped over the counter (partitions to prevent this were suggested to management like they had in other psych wards and nixed as they wanted us to appear to be ‘open’ to patients) attempting to assault the physician. A patient grabbed the doctor’s hair. A patient punched a nurse in the face, causing jaw issues. One tried to press their thumbs into the nurse’s eyes. Another patient charged a staff member and almost got him but it was shift change and as a nurse helped me put the patient into a hold. Which was good because if it would have only been me it would not have gone well.”
But those are just the kinds of risks that the hospital’s CEO was bravely willing to take.