Elderly Man Shuttled In and Out of Hospital : Patient’s Unhappy Odyssey on Medicare

When Jules Weil had lung surgery at Midway Hospital in Los Angeles in 1981, he did not leave until he felt ready six weeks later. But more recently, operating under new Medicare cost controls, Midway discharged him twice before he wished to leave--only to see him rushed back in ambulances several days later.

His wife, Marian, found his treatment unsatisfactory. “My complaint is that a patient as incapacitated as I believe my husband was should have been left in the hospital,” she said shortly before he died in late March.

She blames neither the doctors nor the hospital for the discharges but the federal Medicare program, which was paying for her husband’s treatment. Her grievance, she said, is with the “powers that be, somewhere,” who had changed the way Medicare reimburses hospitals for treating the elderly.

Weil’s unhappy odyssey began late in January, when he checked into Midway with an impacted colon. Two weeks later, he was discharged to a nursing home, despite his wife’s belief that he was too weak to leave.

“I was more than astounded when he was in the hospital less than two weeks and they told me they wanted him moved,” his wife said. “If it were three years ago, I don’t think he would have had to leave.”

That cannot be proven. But Weil, who suffered from emphysema and heart trouble, seemed to be just the type of patient--those afflicted with more than one medical problem and in a physically weakened condition--who is not easily accommodated by a system that bases its reimbursement to hospitals on average patients with average individual ailments.

His wife’s fears were borne out when her increasingly dispirited husband, a retired businessman from Sherman Oaks who had been a lamp fixture distributor, was rushed back to the hospital after a week with respiratory complications, his temperature rising and his blood pressure plummeting.

Again he was soon discharged to the nursing home, only to return to the hospital 10 days later when his temperature exceeded 100 degrees.

Peggy Farber, a nurse who coordinates Midway’s handling of the new Medicare system, insisted that the hospital does not discharge patients who are not medically ready to go. But she noted that Midway cannot afford to keep those who are able to get appropriate care in less costly settings.

“We know that we’re not able to keep people as long as they may want to stay,” she said. “Yes, a patient may have to go back and forth between the hospital and a nursing home. Yes, it’s difficult, but I’m not sure it isn’t necessary. . . . Is Jules Weil an exception? Probably not.”

She pointed out that Medicare stops reimbursing the hospital for its costs when the need for hospital care is no longer “acute.”

That is little consolation to Mrs. Weil, who questioned the financial logic of discharges followed by emergency readmissions. “To my way of thinking, it might have saved Medicare money if they’d left him in the hospital longer than two weeks in the first place,” she said.