Writings and observations

What’s medically necessary

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Being neither a medical nor a legal professional, I’m wary of stepping too far into this intersection of the two arenas. But there’s a large public policy question here worth your, as well as my, consideration.

On July 7 the Idaho Supreme Court decided Sohar Chavez v. Kevin Stokes, a worker compensation case. Chavez worked as an irrigator for Stokes on a farm near Payette; one day in September 2012 his pinky finger was caught and mangled in a piece of machinery. Stokes wasn’t insured for workers compensation but paid without dispute Chavez’ various medical expenses – except one.

After the accident happened, Chavez drove himself to the home of a Payette area law officer, where paramedics tried to treat him. Someone – apparently a paramedic – made the decision to call for the Life Flight helicopter, which flew him to the St. Alphonsus hospital in Boise. A few days later Life Flight issued a bill for $21,201. Stokes paid all the other expenses, but argued that the Life Flight, or at least its cost, was not necessary or reasonable.

The dispute over this has lasted a long time. About a year after the accident a referee was called in, and sought an independent doctor’s opinion. The doctor said the injury to the finger (which was serious enough that it was amputated at St. Alphonsus) was serious but it “was not in any way, shape or form, life critical. For that reason I do not understand why Life Flight was called or addressed in the first place, and why the case was not taken to Holy Rosary. Indeed, it is extremely reasonable that the patient would be taken physically to Holy Rosary Hospital. Had there been an incident which may in some way benefited from a vascular reconstruction, then the patient could be transferred to St. Alphonsus or St. Luke’s. Indeed, this was in no way necessary.”

The Holy Rosary Medical Center at Ontario is a substantial general-purpose hospital located about four to five miles from Payette, and could have been reached in a few minutes. St. Alphonsus in Boise was about an hour away by car, less by helicopter but still a longer trip even by air than to Holy Rosary. The referee concluded that the medical work could have been done properly at Ontario.

There are specific rules and guidelines in Idaho (as elsewhere) covering when a medical procedure is “reasonable,” and in this case the court applied some of those rules and partly reversed an earlier ruling. Overall, the unanimous court said, “We recognize that the Life Flight transport may be seen as arguably unnecessary with the benefit of hindsight, but the evidence nonetheless supports the Commission’s finding that the Life Flight transport was reasonable medical treatment at the time of Chavez’s injury.”

So, the conclusion was that the $21,201 less-than-an-hour helicopter flight was deemed a legitimate medical expense, and had to be paid by Stokes.

As the court’s language suggests, hindsight is easier than real-time emergency action.

Could the same result have been obtained for $21,201 less? It would seem so.

The answers aren’t completely settled and obvious in this area. The question of what was the right thing to do in this case was answered in different ways by various professionals. But the case of Chavez v. Stokes shines a light on why getting a handle on our medical expenses has been so hard, and on some of the discussions we’re going to have to have if we ever hope to bring them under some rational control.

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