Sending Jason home

Patient Jason Smith and hospitalist Mohamad Moussa at Emory Johns Creek Hospital. Note: The life vest portable defibrillator is normally worn under clothing.
Patient Jason Smith and hospitalist Mohamad Moussa at Emory Johns Creek Hospital. Note: The life vest portable defibrillator is normally worn under clothing.

 

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Jason Smith agreed with the urgent care physician that he should go to the nearest emergency room. He disagreed that he needed to go by ambulance.

While looking for a job, he had tried every way he could to keep costs down, not even seeking medical care until his symptoms scared him into it.

Since losing his health insurance, he weighed such options carefully. A little dizzy, he navigated the 12 miles to Emory Johns Creek Hospital (EJCH), where he fell flat on his face in the parking lot, fracturing bones in his cheek and spine. In the hospital's emergency department, a team of white coats diagnosed severe congestive heart failure and atrial fibrillation: chaotic, irregular heart rhythms.

When Smith was admitted to EJCH, Emory hospitalist Mohamad Moussa became the doctor who coordinated his care. There was a lot to address. Treatment of fractures and contusions from the fall. Monitoring and correcting arrhythmias. Medicines for congestive heart failure and the shortness of breath and swelling of legs that had bothered Smith for months now. Echocardiograms, cardiac catheterization, and other tests that showed his aortic artery to be constricted and his ejection fraction, the amount of blood the heart pumps out with each beat, less than half of normal. If the parking lot episode had occurred five minutes earlier, says Moussa, Smith might well have died or been involved in a serious highway accident.

And another attack could happen anytime. The cardiologist Moussa consulted recommended strongly that Smith not leave the hospital unless he were wearing a portable defibrillator, a vest that detects any dangerous change in heart rhythm and shocks the heart back into a normal pattern—marvelous technology that could protect Smith until he was well enough to have a permanently implanted defibrillator. But there was a catch. Smith had neither insurance nor resources. While looking for a job, he had tried every way he could to keep costs down, not even seeking medical care until his symptoms scared him into it. EJCH had declared his hospitalization as charity care: almost $40,000 for which neither the hospital nor the doctors would be paid. But once he left the hospital, who would pay the $3,000-per-month cost of the vest?  

The medical team turned to social services for help. After research and numerous calls by patient advocate Carole Freeman and social worker Cathy Crumrine, a solution emerged. EJCH would pay the first month of costs and the vendor the second and third. An immensely proud man, Smith is determined that by the time he needs the implanted defibrillator he will have a job and insurance. Moussa, Freeman, and the team at EJCH hope for his sake that all that works out, but even if it doesn't, they are committed to getting him the care he needs.

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