Healthcare Update 04-30-2012


Back from a rough week. Satellite Editions of this week’s update at ER Stories and at As always, if you’re interested in posting here or at Medbloggers, drop me an e-mail.

Not a laughing matter. Not even a smiling matter … especially for the patient. Man goes to see dentist for a toothache. Dentist just happens to be the girlfriend that he broke up with three days earlier for another woman. While patient was under anesthesia, the dentist pulls the affected tooth … and all his other teeth as well. Now patient’s new girlfriend dumped him and dentist faces three years in prison.

Former med mal attorney and former presidential candidate John Edwards rejects plea deal and goes to trial to decide whether he violated campaign finance laws by accepting more than $1 million to hide his pregnant mistress. Since the cover-up was exposed, Elizabeth Edwards, his wife, lost her battle with breast cancer. Reporters note that there are many more trial witnesses yet to be called.
One can only wonder whether prosecutors will be able to channel Ms. Edwards’ thoughts in the same way that Mr. Edwards used to channel the thoughts of brain-damaged infants in his malpractice trials.
Karma sucks, eh counselor?

“You keep quiet or I’ll wash your mouth out with soap.”
Kids getting high by drinking hand sanitizer — which has an alcohol content higher than most liquors.

The Feeding Tube Diet?  You have to be kidding me. Brides pay $1,500 to have feeding tube inserted for 2 weeks prior to their weddings so that they can be fed an 800 calorie per day diet. For only $100, I’d tell you to follow the Paleo diet, but then North Carolina would file sanctions against me or something.


Massachusetts cites three hospitals for inappropriately treating patients in emergency department.

According to a study in the Annals of Emergency Medicine, professional translators in the emergency department decrease the number of potentially serious translation errors by nearly half. Only problem is that with cuts in payments to hospitals and providers, few hospitals can afford to have professional translators – especially in areas with multiple ethnic groups.
Now according to ETATA – the Emergency Translation and Active Talking Act – the translators should be providing their services to everyone who needs the services regardless of their ability to pay.
Wishful thinking. At $4 per minute, the translators are making way more money than the doctors who treat the patients.

Excellus Blue Cross Blue Shield insurance company fined $1 million by New York State for inappropriately denying payment for patients’ emergency department visits. After getting caught, the insurance company repaid the affected policyholders and vowed to take “corrective action.”

What happens when a premium is placed on timeliness of emergency department care? Hospital administrators “manipulate” data. This Australian administrator just happened to get caught. If the government officials sincerely think this was an isolated incident and that it doesn’t happen anywhere else, they are naive and should consider resigning.

NY Presbyterian Hospital settles birth injury lawsuit for $5.3 million. Doctors allegedly didn’t take enough steps to prevent a child’s premature birth and as a result, the child was born with cerebral palsy.

Amount of money spent on defending and paying for malpractice lawsuits hits new record. Study done by Patients for Fair Compensation shows that costs increased to $31 billion in 2011, with only $6 billion of that money going to patients and the remainder to legal costs, administrative costs and insurance company profits. In addition, the organization estimates that $650 billion is wasted each year on defensive medicine.
To put things in perspective, though, the leadership for Patients for Fair Compensation is comprised of executives from a physician staffing company, a hospital CEO, the founder of Medical Justice, and healthcare policy wonk/blogger John Goodman.

Want to be a certified forensic consultant? Just pony up $495, watch a video, pass a test, and as soon as your check clears, you’ll get this nice certificate from the American College of Forensic Examiners Institute.
When you’re done, you can also get a Certification in Homeland Security. The Navy has paid more than $8.5 million for sailors to obtain similar credentials.
The Chair of the ACFEI Advisory Board is Cyril Wecht, the famous pathologist and former Allegheny County Coroner.



  1. Quote: “Wishful thinking. At $4 per minute, the translators are making way more money than the doctors who treat the patients.”

    Can you tell me where interpreters earn this much money in a hospital environment? Seriously. I worked as a contract interpreter (by far the most common situation) from 2003 through last month before finally giving up because I couldn’t make a living wage.

    In Portland, Oregon I made $15/hr and was not paid mileage or parking. I had to go shooting all over town to different appointments. On a good day I would be out and about for 10 hours and clock up six hours of work and often over 100 miles on the car. If the hours fell outside of the 8am through 5 pm window I got an extra dollar/hour. To achieve more than 4 hours a day I had to work with two agencies, which had it’s own “availability” problems and I was offered less work by each agency in light of the fact that they couldn’t know I’d be available.

    In Seattle I got $25/hr. Occasionally I’d get milage, but for the most part the agencies make the interpreters pay all costs. My calculation was that I could earn $100 dollars on a good day, and drive 25-70 miles (-12.50 to 35 dollars) and remove $7 for parking. and pay $30 in taxes later. Since the mileage cost is sort of hidden in expenses and the parking is out of pocket and we never think of taxes when calculating what we earn, let’s say I got $80.00 on a good day and that I had three good days a week. That makes it somewhere in the region of $350 a week.

    When I worked phones I was payed 25¢ a minute. I was on the phones for twelve to fifteen hours a day. That meant sit and wait and answer on the first ring. I couldn’t use a mobile, so sit at home and wait. I usually got enough calls for 80 to 90 dollars a day… breaks down to five hours of paid time for 10 to 12 hours of sitting.

    When the economy took a down turn, hospitals and medical groups went back to “Doesn’t anybody in your family speak English?” and non-English speaking patients stopped going to the doctor when they needed it.

    I interpret Spanish. I’m good and I am hard working. I could get those hours because the agencies trusted me to represent them well and called me first. Somali, Eritrean, any of the arab languages, Russian, Chinese, Laotian, Cambodian… most of those interpreters couldn’t get the number of hours I got because there aren’t as many patients in any one area.

    Now what *I* got and what the agency got are very different numbers. When I was earning 12.50 and 15.00 an hour the agency charged $45.00/hour. When I was earning $25.00/hour, the agency got between $85.00 and $100.00 and hour. I frequently was sneered at by medical personal for being a leech and living off of other peoples needs.

    I could go on and on about how interpreters often work in very hostile environments due to medical personnel not understanding the economics and the dangers of treating without a competent interpreter. And I saw some doozies happen. But $4 a minute? I don’t believe it!

    • Mr. Salmon:

      Cost: have to cancel clinic suddenly and run to ED to see intoxicated individual from guatamala whose family only speaks a Myan dialect. I am not being paid, infact, I lost all the productivity of my clinic and practice to take care of this person who was shot when his drug deal went bad. I am paying to take care of this individual. I also have to pay the cost of the translator if the patient does well and is able to come to post-op appointments.

      • Kier Salmon on

        By the way, a translator translates the written word, and an interpreter interprets the spoken word.
        Yes, I see how upset and angry you are at the situation. It pays you nothing (why do you do it? Is it a requirement for another job that does pay?) and costs you time, effort and patients.
        But to bitch at the interpreters for what they earn — or rather, cost! really isn’t productive or helpful. And it makes you mad which then interferes with your ability to treat the mayan speaker and treat the interpreter with the same respect you’d grant a nurse or EMT.
        You posted the link for the interpretive service that quotes $3.99/minute. This strikes me as pretty unrealistic. In the first place, that’s what the agency is charging you; not what they pay the interpreter. And I can assure you that the interpreter does not get that. However, easy common languages like my spanish earn low dollars, rare languages such as Maya and Cambodian earn much more–they are rare! So if they quote that global price, they aren’t being honest. Or they are *really* stiffing their interpreters.
        But I’m sure your nurse, the EMTs, the lab technicians, the receptionist, the supervisor in the ER are also making money. Your comment in the original blog Wishful thinking. At $4 per minute, the translators are making way more money than the doctors who treat the patients. simply demonstrates a complete lack of understanding of the world of working as a contractor and sub-contractor. SHould any of them actually get paid $4/minute, I’ll bet you oranges to apples that they work less than 100 minutes a month. And they’d sure like better pay or more hours.

      • The big problem we have with the mandate to provide interpetation/translation is who is paying for the mandate. As it stands, a person can come into your office, hospital, clinic and by law you have to provide an interpeter or translator at your expense. At our center we have the blue phones which the patient picks up one receiver and the medical person the other. It is $34 dollars to initiate the call and 8 dollars a minute after that regardless. This cost must be eaten by the facility, doctor, clinic etc.

        So everyone else is getting stuck taking care of the person at their own expense while the interpeter/translator is making out like a bandit.

      • Kier Salmon on

        I will repeat. The INTERPRETER does not “make out like a bandit.” The interpretive agency DOES. But you go meet an interpreter in the flesh and blood and ask them how much of that money reaches their pocket and they will laugh their heads off. If they get 25 cents a minute of the $4 + $38, I’ll eat crow.
        I know the law makes you upset, but you risk malpractice when a family member or guy off the street says “lung” and means “kidney” (and I’ve seen that happen!) and the interpreter is the low man on the totempole and does not get that money… it goes to all the middle men.

  2. Why would they factor insurer profits into the “cost” of malpractice? If they make income from their investments, how does that cost the patient or system anything beyond the original premium dollar?

      • If the situation were “dollar of profit=dollar of reduction in premiums” I would understand. But that’s not how a mutual works. Those profits can just as easily be distributed as dividends, or kept as retained earnings.

        Either way, those profits do not constitute a “cost” to the system.

  3. DensityDuck on

    but I can’t stop eating, you don’t understand, I can’t stop it’s too hard I have these cravings and I just caaaaaaaaaaaaaaan’t

  4. I am an interpreter who works both over the phone and in person. The rates for Arabic Interpreters is $20 to $24 an hour for onsite Arabic interpreters.
    I am also a doctor in my country. Interpreters get very few hours of work per day, because there are many agencies and many interpreters. Out of that small amount per hour, we have to pay taxes, commuting and parking expenses. We are paid only for the times we are at the clinic. For example if it takes 35 minutes each way, then I have to drive more than an hour, at my own expense time wise, gas, auto expenses etc. Many times, over 60 percent of the assignments are one hour only. Clinics are very keen not to keep the interpreter in the waiting room like other patients. I know that the agencies, with whom we are contracting with, make much more money and the medical personnel think that we are overpaid! For your information, that type of interpretation cannot , I repeat CANNOT make you able to live off that sort of spotty income. It is only like 300 to 700 a month if the agency likes you and are available to go everywhere they request. As for me, I have learned that it is in my best interest to stay within 10 miles from where I live. For OTP ( over the phone interpretation) they refused to pay me any cent above $0.50 a minute and they pay per minute. I learned from one provider I was interpreting for, that she was paying the agency $ 1.50 per minute. She was urging the non English speaking patient to learn English ASAP so she won’t have to use the interpreters. Thus, we get less than 1/3 what they are charging the clinics/ providers. Needless to say, pay rates have not increased but rather decreased in the last few years in spite of the inflation and rising gas prices. We get no benefits whatsoever, no paid vacations, insurance etc. If you are not able to work one day due to illness or an urgent appointment, your pay would be zero dollars. I never heard about $4 a minute from any interpreter.

    • Kier Salmon on

      Thanks. I’ve posted very similar numbers before, but nobody’s listening and last month I finally walked away from interpreting.

      It hurt to leave a job I love so much, but I was getting less than $1,000/month and I can’t live on it. Now I get $9.50/hour for 35 hours a week, which is pretty low for the hard work I do as an office assistant, but at least I’m working regular hours, and someday I’ll get a better paying job.

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