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Is the Economic Deck Stacked Against Healthcare for the Elderly?

That’s the question posed by a reader named John from New York City. I am not sure whether he wrote in response to our New York Times column on hand-washing, which has prompted a lot of e-mails on all matters medical. Regardless, John raises an intriguing and important question whose answers I know nothing about, but I’d love to learn more. As he puts it in his e-mail, “Hopefully, together we can initiate a long overdue debate and bring some much needed attention to this particular topic.” Let the debate begin here.


Obviously, there’s no shortage of discusion with regards to the need to improve the quality of healthcare in this country, but one area of deficiency could easily affect your beloved grandparents or parents just as it has my mine. It has to do with the need to improve the quality of healthcare for this nation’s elderly. Any one who’s had an elderly loved one infirmed knows all too well that the elderly can receive a substandard level of care in our system.

In short, why is it that the quality of care is so good in maternity wards and pediatric care units, while it oftentimes borders on malfeasance in the wings that cater to the elderly? I know what I speak of as I recently had both my year-old daughter and my mother in critical care situations. The quality of care was demonstrably different. My daughter received an incredible quality of care and is thriving after her heart defect was diagnosed and treated. My mom, on the other hand, received such a pitiful lack of quality and compassionate care that she succumbed more to med malpractice than what she was admitted her for, a fairly benign stomach and kidney ailment.

The answer lies in the economic value of a child vs an elderly person, and how that serves to strip out any semblance of accountability on the part of the nuses, doctors, and hospital who are treating the elderly. As a result of my mom’s tragic situation I complained to the NY State Dept of Health about this particular hospital.

The NYSDOH subsequently cited the hospital for 13 violations in my mom’s case. I took those findings to many top notch med mad attorneys in New York City. Very experienced attorneys who said “they’ve seen it all” yet said they’d rarely seen such negligence as in this case. I wasn’t seeking jackpot justice, I was just trying to impact change at that hospital. The end result was that I couldn’t find a single attorney who thought twice about taking the case. Essentially, as much SHOCK VALUE as there was in this case there was no ECONOMIC VALUE in the case. My mother was 79 years old, all her chidren grown and on their own, and she had been a housewife for most of her life. In our system of torts, where everything is based on compensatory loss of future earnings, future medical expenses, other misc expenses, and the pain and suffering of the patient, there was little in the way of possible damages other than funeral expeses. The cost of litigation being in the area of $100K, no rationally minded attorney would take a case with that low a cost/benefit.

It’s sadly ironic that this situation actually creates a more perverse disincentive where it’s cheaper to kill the elderly patient than just maim them and possibly pay a few more years of compensatory medical care. With no med mal recourse we have a situation where a huge layer of accountability is stripped away, and the incentives to providing the highest quality of elderly care is severly compromised. Yeah, there’s some regulatory pressure but the free market mechanism of holding someone accountable with a jury award is far more effective than the ire of government bureaucrats who have to balance many more considerations when deciding how to discipline that hospital, and are ultimately forced to water down any possible sanctions.

The antithesis of this situation is the care children receive with their medical needs. If a med mal situation develops with a child all the parties responsible are held liable for decades of lost earnings potential and compensatory medical exenses. This changes the equation dramatically. The financial implications are profound if a doctor or hospital is found negligent in permanently injuring a child. That why hospitals carefully
place their best nurses in the pediatric wings, and the worst are left to care for the elderly. That’s why the nurse to patient ratios are higher in the pediatric wards. That’s why the technology and the facilities in the pediatric wings far surpass that of the elderly wards. The care in pediatric wards is far better, the mistakes are fewer, and the outcomes are far better.

With 78 million baby boomers who start turning 70 years old in another decade, it’s a public imperative that we improve the quality of the healthcare for our elderly. Too many in the people in the “Greatest Generation” have already suffered unnecesarily.