By Olivia Lounsbury, Clinical Intern, Patient Safety Movement Foundation
While you may not have heard of Amy Vilela, she has been at the forefront of fighting for patients and patient safety since 2015, when her daughter died after being unlawfully denied access to medical care.
Read on to learn more about Amy’s story, the ways in which she has been working to improve healthcare access for everyone, and the issues she brought to light in the healthcare industry.
In 2015, Amy’s daughter, Shalynne, showed up at the Centennial Hills Hospital Medical Center in Las Vegas, Nevada. Shalynne’s symptoms and risk factors were classic of a rare, life-threatening condition called deep vein thrombosis. Also known as DVT, the condition occurs when a blood clot forms in the body; DVT is deadly if left untreated, but survival rates are excellent — about 95 to 97% — with adequate medical care
Walking into the hospital, Shalynne wasn’t sure if she had healthcare or not. The hospital took her temperature and blood pressure, but When Shalynne mentioned that she did not think she had medical insurance to the hospital staff, the staff was of little help. They told her to get insurance and see a specialist, since, as an emergency room, they were not a doctor’s office. They did not satisfy even the bare minimum requirements for a patient presenting as Shalynne did, denied her repeated requests for testing, essentially telling Shalynne to go home. In other words, the hospital showed a lack of patient engagement, denying her proper care.
Because Shalynne couldn’t show proof of insurance, she couldn’t obtain adequate treatment. Without access to medical treatment, Shalynne died shortly thereafter.
After Shalynne’s death, Amy was going through some papers when she discovered that Shalynne did, in fact, have health insurance at the time. The problems that Amy had experienced firsthand were twofold: first, her daughter could not present proof of insurance, even though she presumably had been covered, and second, all patients deserve treatment regardless of insurance status.
Amy’s tragic loss motivated her to make a difference. She became an advocate for improved healthcare access, even launching a campaign for Congress in her home state of Nevada during the 2018 midterm elections, in which she finished at third place. Her journey on the campaign trail is featured in the Netflix documentary “Knock Down the House.”
Today, Amy continues to fight for improved access to medical care for those without health care coverage. Amy is a fierce supporter of Medicare for All and has worked tirelessly to improve health care access for the 29% of Americans who are underinsured, including 27.5 million Americans without any insurance, so that they do not encounter Shalynn’s tragic fate.
The Sad Reality of “Patient Dumping”
There is an inherent duality in the medical field — there is an obligation to treat patients, but as the case of Amy’s daughter Shalynne demonstrates, money can have an unimaginable influence.
Shalynne’s tragic fate was due to an illegal practice called “Patient Dumping,” which occurs when hospitals refuse to treat patients without insurance. Technically illegal, the practice is supported by the profit-oriented medical system — treating insured patients is more lucrative for hospitals than treating underinsured or uninsured patients.
Patient Dumping is a consequence of a healthcare system that falls short by incentivizing the treatment of insured patients with hospital reimbursements. And when the larger healthcare system is failing us, we must fix what’s broken, instead of casting blame on doctors and hospital staff for trying to work within a flawed system. We must reflect on organizational structures that promote error to improve and build a culture of safety. A system that works — treating all people who need it, regardless of insurance status — is a system that keeps patients safe.
The Uninsured Face Barriers to Health Care
The truth is that emergency rooms must treat anyone who walks through their doors, regardless of insurance status. This patient right, which was ignored in Shalynne’s tragic case, is derived from the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA). EMTALA states that anyone showing up at a hospital that accepts Medicare or Medicaid for care must be treated by the on-call physician. Yet patients without insurance can often have an entirely lesser standard of care than the insured.
Doctors have less time to see uninsured patients, leaving them for after the insured patients have been seen, and there is no reimbursement structure from insurance to see uninsured patients. Also, uninsured patients arriving at the ER lack access to preventative care, which means they may actually be suffering from more serious conditions than the insured, who have access to routine preventative care.
We must acknowledge the dissonance between profit and care in the medical system, particularly for those without insurance. It’s easy to understand Shalynne’s tragic death was a consequence of this broken system. The good news is that hospitals can take many steps to improve care for the uninsured.
Improving Health Care for the Uninsured and Underinsured
In 2018, 29% of Americans were underinsured, with 41% of underinsured adults delaying needed health care due to its high cost. The number of uninsured have increased in recent years despite passage of the Affordable Care Act (ACA). This disparity deters uninsured people from obtaining preventative care, which means they may visit the emergency department only when their health problems become severe, and by that point, their health problems may require more complicated treatment, but, as Shalynne’s case shows, they may also be illegally turned away because treating them is costly or time-consuming.
We must acknowledge that the health care system is not inherently designed to address this disparity in health care so we can take steps to improve the standard of care for all patients. As a result, hospitals must work towards improving the standard of care for the uninsured. Adherence to the law might be more effective if hospitals work towards implementing effective triage measures to reduce waiting times, give priority to those with most critical conditions, and optimize cost and compliance. EMTALA is also very vague in defining the requisite medical screening that hospitals must legally provide. While government-funded committees have sought to study this and provide guidelines, these efforts have not gathered much steam. Therefore, the medical community should work to define a best practice guide for medical screenings.
Only by taking steps to protect the health of uninsured patients can we help eradicate the tragic and preventable loss of patients like Amy’s daughter, Shalynne.