Posted on May 3, 2019 at 1:52 AM
by Craig Klugman, Ph.D.
Exploring bioethical issues in television medical dramas
New Amsterdam (Season 1; Episode 19): Privatizing the VA; The Resident (Season 2; Episode 22): Organ buying; Grey’s Anatomy(Season 15; Episode 23): Insurance Fraud
A veteran has a stroke while driving and injures a police officer. We learn that the driver was diagnosed two years earlier with bladder cancer, which has led to his current stroke. He could not get treatment because the VA closed the urology division in a rush toward privatization. The voucher to get care elsewhere only covers 75% of the cost of care and the patient cannot afford the rest. As a public hospital, New Amsterdam is willing to cover the remaining amount, but the CFO refuses to allow this because it sets a dangerous precedent to encourage privatization. The cost savings will be made up for by other hospitals, a response that is not sustainable.
By sending resources to private hospitals and providers, less money is available for the public VA facilities and providers dedicated to veteran care. The effort is part of a political desire to close public facilities and shrink the government. The result of this effort is longer waits for vets, and higher costs. The cost of private care is far higher than it is in a VA facility, but privatization was rushed through with support of the current presidential administration. According to financial reports, the only beneficiaries have been the private companies. If hospitals are willing to make up for the problems with these programs, then the programs look successful, even when they are failing.
Jesse is Nevin’s sister, a recovering opioid addict (2 months sober) who is in kidney failure when her heart starts failing. Nevins is not a match to be a donor, though her father is. He, does not have faith in his daughter’s sobriety and is refusing donate. Nevins speaks with Bell about waving the hospital policy that a person must be sober for 6 months before being placed on the transplant list. Bell says that if they change it for her, then they have to change the rule for others and it leads down “a slippery slope”. Nevins points out that other hospitals have shorter time periods and that Jesse should not be punished for her addiction, which is a medical condition. Bell replies that the hospital has “an obligation to honor the donor’s sacrifice by ensuring that each organ has the greatest chance for success.” Of course, he forgets that the cause of kidney failure was a corrupt drug trial the hospital sanctioned.
Desperate, Nevin meets with an organ broker who wants $100,000 for a kidney. The broker also says that Jesse not being on the transplant list is not a problem because “doctors can be bought”. The kidney seller is a 30-year-old waitress at a restaurant. The broker will create a cover story of a past connection between seller and buyer-patient. The broker keeps 90% of the fee, which is why Nevins chooses not to buy the organ.
In the United States, buying and selling organs is illegal. Organs are normally made available via a non-profit donation system. The main reason for the illegality is that most donors tend to be people desperate for money (usually poor and vulnerable). Most buyers are wealthy and this becomes exploitation of people living in poverty, who are sacrificing their own well-being for a chance of hope. Someone selling a kidney outside the organ donation system is one less organ for the system. People who are good medical candidates and have been on the waiting list miss out. Plus, most of the money goes to the organ broker, not to the seller. Around the world, organ brokers help sick people exercise their privilege at the cost of the health of people in poverty.
A young girl has recently come to the United States from Central America. Her father came first, got a job, an apartment, and paid his taxes to bring his family to a safer place. When she is sick, they go to Grey-Sloan. Dad does not have insurance through his custodial work, but because of a Washington state law, his daughter gets evaluated for free. When Grey discovers that the girl has a mass in her colon that requires surgery, the father applies (15-minute process) for the state insurance that will cover surgery. However, the earning cap for that plan is so low, that as a custodian, he makes too much money. To treat the girl, Meredith registers her daughter (similar age) as the patient and then operates. Grey says, “The system failed them. The system is broken.” Grey commits insurance fraud. Weber later reads her the riot act but then becomes complicit, saying that if they can keep her in the hospital for 30 days, then a new policy goes into effect and the name borrowing won’t matter.
Grey is correct that the system is broken. Many of the working poor can buy insurance because of subsidies available through the ACA marketplace or Medicare expansion. But those options do not apply to immigrants (especially undocumented ones). Grey’s actions are illegal. Insurance fraud is a crime. Ethically, she did put her patient first, but she did that only by lying and cheating. The system may be broken but that does not justify this behavior.