It all started with peanuts and a baby raccoon. And then, 67-year-old Lynda Parsons ended up in the emergency room -- five different times.
The Louisvillian started feeding the raccoons in an attempt to distract them from eating her cat’s food.
“I thought, they might like peanuts, and as I was throwing a peanut, one of them thought my thumb was a peanut, and he took just a little bite,” she said.
So, Parsons went to her primary care doctor, where she got a tetanus shot. But the real risk from a raccoon bite is rabies. Treatment includes a series of five shots, and the first shot has to be given within a day of the bite. Since it’s an urgent situation, the Jefferson County Health Department has always sent people to the emergency room for that initial treatment.
But typically, the four follow-up shots came from the health department or pharmacies. And that’s because using the emergency room for routine health care is expensive.
Parsons' case was an ordeal for her. But it also shows the seemingly untenable complexities of the American health care system seven years after Congress passed the Affordable Care Act. And it suggests possible solutions.
A 2010 study estimated up to a quarter of ER visits in the U.S. could be managed by physicians, clinics and urgent care centers, which would save about $4.4 billion annually. That expense is part of the reason recent health reform efforts have focused on getting people to primary care physicians and freeing up the ER for true emergencies.
Earlier this year, Parsons could have gotten her four follow-up rabies shots at the Jefferson County Health Department. But spokesman Dave Langdon said the health department stopped offering those because they’re expensive, and not enough people are using them these days to make it cost-effective.
“It’s kind of the same deal as a lot of immunizations," he said. "They’re much more widely available now. you can get them at Kroger Little Clinic, CVS, Rite-Aid.”
But after calling a few of those places and being told they didn’t have rabies treatments, Parsons thought she was left with one choice: go to the hospital emergency room for all five shots. So that’s what she told her emergency room doctor, Robert Couch, at Norton Brownsboro Hospital in Louisville.
“What’s crazy is she’s going to have to come back to the hospital four more times to get these injections,” Couch said. “When if we just had a system in place to have them go to Walgreens and get it, it’d be so much easier.”
And five emergency room visits add up. Getting the shots there will end up being much more expensive than they would have been at the doctor’s office. And it’s really not what the ER is meant for, said John Ayanian, director of the Institute of Health Care Policy at the University of Michigan.
“Emergency departments have a substantial standby capacity because the staffing and technology that is required to treat true medical emergencies, like treating a heart attack or stroke,” he said. “And when people use the ER for more routine problems like a cough, they're often paying for much of that standby capacity that isn’t required for more straightforward medical problems.”
Parsons has Medicare, the federal insurance program for those over 65, and was told she’ll have to cover 20 percent of the hospital costs. But she also has Tri-Care from her days in the military, and hopes that will cover the rest.
“I called Medicare and alerted them to the fact that they’re going to see four ER charges in two weeks, which could be eyebrow raising, but they said it would be covered,” Parsons said.
After all this, and after five ER visits, it turns out there was another option for Parsons.
CVS Pharmacy said they could have pre-ordered the treatment and sent it to her primary care doctor to administer. And Kroger’s Little Clinic actually does have the shots, and could have administered them.
But no one told Parsons this, and in some cases, she was outright misinformed. Plus, connecting these dots, even for a reporter used to navigating the landscape, took days of gathering information from all the pharmacies and clinics in town.
Ayanian said what Parsons really needed was someone to coordinate her care. He said it should have been up to the health department to gather all this information and help Parsons avoid so many ER visits. The rare rabies case is, of course, a public health issue.
But for Parsons, the whole debacle turned out to be a lesson in the complexities of the health care system. And maybe not to feed peanuts to raccoons.
