VA mix-up may cost man $20,000 Surgery done at Mercy after VA unit closes temporarily.


A 64-year-old Baltimore veteran is facing more than $20,000 in hospital bills after hip surgery at the Mercy Medical Center because the VA hospital on Loch Raven Boulevard shut down its non-emergency orthopedic service temporarily and said it could not admit him.

"It's like you got to University Hospital and there's a sign on the door that says, 'Come back in a week,' and you're hovering around in a helicopter. It's unheard of," says Dr. Kenneth R. Lippman, the veteran's surgeon at Mercy.

The veteran, whose bill would have been paid by the Veterans Administration had the operation been performed at the Loch Raven Hospital, has declined to be interviewed or allow his name to be used.

Anita Healy, a patient representative at the VA hospital, says the orthopedic service closed last weekend because it is ending its affiliation with surgeons from Johns Hopkins Hospital. A new affiliation with the University of Maryland Medical System doesn't begin until July 1.

The switch is being made in preparation for the hospital's Nov. 8 move to the new $121 million Veterans Affairs Medical Center downtown, adjacent to University Hospital.

"I wouldn't call it a gap," Ms. Healy says. But until the affiliation with University Hospital is official on July 1, the VA hospital cannot offer any elective orthopedic service. Only emergency cases can be admitted.

Dr. James Dean Michelson, an assistant professor of orthopedics at Hopkins and outgoing chief of the orthopedic service at the VA hospital, calls the episode "an incredible bureaucratic snafu." He adds: "One of the most important things we do as physicians is communicate. It's clear there was a breakdown here, and hopefully everyone who participated in it will learn."

Dr. Lippman says the veteran was first taken to Mercy Hospital Saturday night, June 13, with a "standard, garden-variety" hip fracture. He needed surgery for implantation of an artificial hip joint.

Because the man was worried he could not pay for care at Mercy, Dr. Lippman set about on Monday last week to arrange a transfer to the VA.

He says the resident orthopedic surgeon at Loch Raven explained that the service was "very busy" and would be unable to treat the veteran "for some time." At first, the VA began paperwork to admit the man so that he could await surgery as a VA patient. But Wednesday, Dr. Lippman says, VA officials again said they could not take him.

Dr. Michelson says that if Dr. Lippman "got that impression, I don't know where he got it. I know we didn't tell him that."

Dr. Lippman says a social worker at Mercy, Agnes Edwards, then called Sen. Barbara Mikulski's office for help.

After a short time, Denise Nooe, a staffer in the senator's Annapolis office, called back and said the VA had agreed to take the patient Thursday morning. "So we think this is pretty good," Dr. Lippman says.

On Wednesday night, however, the man's condition became unstable, and the transfer to Loch Raven was postponed. By Thursday night, he had improved.

"So first thing Friday morning, I call the VA and talk to the medical resident over there, and he said, 'OK, we'll take him today. Just do some paperwork for us,' " Dr. Lippman says. At this point, his patient "is happy; he's been waiting all week. Then the VA calls back and says the orthopedic service is closing . . . as of Friday afternoon." It's too late to admit him.

Fearing the man might develop pneumonia or blood clots if he waited any longer, Dr. Lippman ordered the surgery for the next day at Mercy.

Asked why he didn't try to transfer the patient to the VA hospital in Washington, Dr. Lippman says, "I didn't really see that as an option. To put a guy in an ambulance with a broken hip . . . for 50 miles? I don't think that's safe."

Lucy Fleming, chief of medical administration service at Loch Raven, says that if the veteran had been well enough for transfer from Mercy Thursday as scheduled -- while the elective orthopedic service was still available -- he could have had the surgery Friday and "he would have received no bill."

He also could have received the surgery at government expense if it had been deemed an emergency. A Hopkins orthopedic surgeon remains available at Loch Raven for emergency surgery only, Ms. Healy says.

But because this veteran was "in a health-care facility [Mercy] that could provide the care he needed, the decision was made that this was not an emergency. That is why the patient was not transferred," she says.

Because he had the operation at Mercy, the man is on his own financially, however. The VA will not pay for care at a non-VA hospital unless the injury or illness is service-connected, Ms. Fleming says.

VA spokesman David Edwards says no other patients have been affected this way by the hospital's changing medical affiliations.

Dr. Michelson says that Dr. Lippman should have spoken with him directly.

If he had, he says, "we would have taken him. I would have made arrangements for [the veteran] to be on the general surgery service. They still have residents, and I would have done the surgery."

"I went into medicine to take care of patients," he says. "I feel very badly this guy ended up sitting in the hospital for a week without getting operated on. That's not good medical care."

The veteran is recovering at Mercy. He will remain there for several more weeks and will then need physical therapy. Dr. Lippman says he has waived his own fee for performing the surgery. "I'm not going to expect anything from him for it," he says.

For now, Dr. Lippman says, his patient is "concerned" about his mounting medical expenses, but is "confident the VA will pay the bill."

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