Shands UF Hyperbaric Chamber Closed.

[Cindy]

Look up EMTALA. You will get appropriate and prompt treatment at any ER. There they will stabalize you and determine the best plan of treatment. In DCS that will usually mean a chopper ride to a 24 hour chamber.

Chambers are rembersed only for the dive. Weather it's s 2 hour wound treatment or a 5 hour navy 6 table. The rembersment is the same rate. Again, do the math. One diver tying up a chamber and 3 medical staffers, or 3 wound or burn patients. Sorry just a taste
of reality. Ken

This is why I have not been posting. I don't seem to be clear. The reality is:
a. The chamber is running the same as it always had been. There were no "extra" costs. It is still open during banking hours Monday through Friday. No diver has ever, ever caused the chamber to no be able to do other medical treatment. They don't even do wound care at Shands. This problem is about emergency call on weekends and at night. The MDs that covered did so on a volunteer basis. They just got tired of it. The whole "we have to hire two docs to cover. They are needed elsewhere" is BS these guys are senior MDs. All they have to do is sign off and be responsible. They just don't see the value anymore to them personally. Any pay would be better than none or hell just keep signing and save a couple lives a year. I didn't cost them anything.
b. The cost of the nurses call was very low. They only had to pay the staff a buck and hours unless they had to go in. I would think the $15,000+ they charge would continue to cover that. Again, one nurse with a little pull didn't want to be on call.
c. If anything the divers gave the chamber more money. When I was there they were treating one person. I know the chamber could use extra money.
D. This is about a few people not understanding or valuing others. A Neuro hit has to be handled in two hours. Do you know even one ER that can evaluate someone and transfer them to another chamber in two hours? Also they will NOT transfer you from one ER to another for free. If the diver does not have DAN or another insurance they will not get emergency transport. I know at last three people who are alive because of the rides they took at night in the Shands Chamber.
C. This is also about a few people who got emergency treatment after hours for Carbon Monoxide illness. They will suffer also.
D. It would take very little effort to "fix this". Why not try? Do the math, it cost them very little to save one of us. Why not continue to do this?

[RN]

Also they will NOT transfer you from one ER to another for free.

This is not true. I worked in several facilities in Arizona both large and small and larger hospitals with specialized services could not refuse ER to ER transfers based on ability to pay. Refusing is a huge EMTALA violation and will cost the larger facility a $50,000 fine.

[MORGAN]

Both Cindy and Rob are correct. They will transfer you if necessary, and it won't be free.

One of my jobs (Don't all RN's have more than one job?) is as an ER charge nurse, and the other is on a critical care transport team operated by a university teaching hospital. Patients are transferred from one hospital to another for specialty care without regard to ability to pay. Lots of the people we transfer are uninsured and in many cases unemployed and indigent. ER, ICU, and CCT staff don't care whether you can pay or not. In an emergency, patients get the care they need, whether they're a homeless person, a CEO, or a homeless ex-CEO. Any hospital that accepts federal funding, including Medicare or Medicaid payments, is required to provide care without regard to ability to pay.

On the other hand, as Cindy points out, it's not free. The hospital billing and financial services departments will be sending you a large bill, and expecting you to pay it, whether you have insurance or not. They may end up taking partial payment or writing some or all of it off, (most hospitals provide millions of dollars in care every year that they don't get paid for) but not until they have done what they can to get paid.

I just renewed my DAN insurance!

Mike

[MORGAN]

...being dehydrated or overweight, or over 40.

That's me, 2 out of 3!

Mike

[divindoc]

This is why I have not been posting. I don't seem to be clear. The reality is:
a. The chamber is running the same as it always had been. There were no "extra" costs. It is still open during banking hours Monday through Friday. No diver has ever, ever caused the chamber to no be able to do other medical treatment. They don't even do wound care at Shands. This problem is about emergency call on weekends and at night. The MDs that covered did so on a volunteer basis. They just got tired of it. The whole "we have to hire two docs to cover. They are needed elsewhere" is BS these guys are senior MDs. All they have to do is sign off and be responsible. They just don't see the value anymore to them personally. Any pay would be better than none or hell just keep signing and save a couple lives a year. I didn't cost them anything.
b. The cost of the nurses call was very low. They only had to pay the staff a buck and hours unless they had to go in. I would think the $15,000+ they charge would continue to cover that. Again, one nurse with a little pull didn't want to be on call.
c. If anything the divers gave the chamber more money. When I was there they were treating one person. I know the chamber could use extra money.
D. This is about a few people not understanding or valuing others. A Neuro hit has to be handled in two hours. Do you know even one ER that can evaluate someone and transfer them to another chamber in two hours? Also they will NOT transfer you from one ER to another for free. If the diver does not have DAN or another insurance they will not get emergency transport. I know at last three people who are alive because of the rides they took at night in the Shands Chamber.
C. This is also about a few people who got emergency treatment after hours for Carbon Monoxide illness. They will suffer also.
D. It would take very little effort to "fix this". Why not try? Do the math, it cost them very little to save one of us. Why not continue to do this?

As to (a.), Medicare requires that the physician be immediately available to the chamber if a patient is being treated, the physician can't just "sign off" on a treatment or the bill may be found t be fradulent per Medicare (and by default, other insurers) guidelines. If you're treating patients in a chamber 24/7, the physician has to be physically on-site and immediately available to the chamber 24/7. And Yes, physicians do get tired of working all night(!). As an emergency physician and active diver, I find the whole situation distressing. Too bad the chamber isn't immediately contiguous with the Emergency Care Center, then the emergency physicians could staff it (they're there 24/7 anyway).

[pwl4476]

This is why I have not been posting. I don't seem to be clear. The reality is:
a. The chamber is running the same as it always had been. There were no "extra" costs. It is still open during banking hours Monday through Friday. No diver has ever, ever caused the chamber to no be able to do other medical treatment. They don't even do wound care at Shands. This problem is about emergency call on weekends and at night. The MDs that covered did so on a volunteer basis. They just got tired of it. The whole "we have to hire two docs to cover. They are needed elsewhere" is BS these guys are senior MDs. All they have to do is sign off and be responsible. They just don't see the value anymore to them personally. Any pay would be better than none or hell just keep signing and save a couple lives a year. I didn't cost them anything.
b. The cost of the nurses call was very low. They only had to pay the staff a buck and hours unless they had to go in. I would think the $15,000+ they charge would continue to cover that. Again, one nurse with a little pull didn't want to be on call.
c. If anything the divers gave the chamber more money. When I was there they were treating one person. I know the chamber could use extra money.
D. This is about a few people not understanding or valuing others. A Neuro hit has to be handled in two hours. Do you know even one ER that can evaluate someone and transfer them to another chamber in two hours? Also they will NOT transfer you from one ER to another for free. If the diver does not have DAN or another insurance they will not get emergency transport. I know at last three people who are alive because of the rides they took at night in the Shands Chamber.
C. This is also about a few people who got emergency treatment after hours for Carbon Monoxide illness. They will suffer also.
D. It would take very little effort to "fix this". Why not try? Do the math, it cost them very little to save one of us. Why not continue to do this?

I don't understand a. When I was in the chamber in late May, staff shared that hyperbaric treatment of wounds and diabetic related issues were regularly treated, and in fact would immediately follow my ride. The staff was proud of the history of their chamber, its role in the history of flight/space development, and its size which fits 3-4 non-DCS patients. Good folks, good program.

Also I wasn't permitted to start treatment without the DR on site giving the order and after the ride checked in with him before leaving. It's clear that they had a responsible DR on site that night. My perception was that the ordering doctor was a regular emergency room doctor already on duty and still there when I left.

pl

[Cindy]

As to (a.), Medicare requires that the physician be immediately available to the chamber if a patient is being treated, the physician can't just "sign off" on a treatment or the bill may be found t be fradulent per Medicare (and by default, other insurers) guidelines. If you're treating patients in a chamber 24/7, the physician has to be physically on-site and immediately available to the chamber 24/7. And Yes, physicians do get tired of working all night(!). As an emergency physician and active diver, I find the whole situation distressing. Too bad the chamber isn't immediately contiguous with the Emergency Care Center, then the emergency physicians could staff it (they're there 24/7 anyway).

Shands has a huge ER and Trauma center in the same building. They examine the divers. Please call them and let them know how you feel. Email me at cindyb3007@yahoo.com and I will give you the directors number, maybe they would explain it to a Doctor.

[fno]

Cindy, since you have already contacted a bunch of people about this, can you post their contact info to speed up the process and direct it to the decision makers. Thanks, Frank.

[Cindy]

Cindy, since you have already contacted a bunch of people about this, can you post their contact info to speed up the process and direct it to the decision makers. Thanks, Frank.

That info is in the first post. Bluetickle works there. Neither of us can be in the middle of this. We have conflicts of interest. I like getting paid for one thing. I am not posting the personal phone number of anyone on a public forum. Shands has a web page and you can always just call and ask for the offices of the people noted in the first post.

[Skybluewater]

IWR is back in style!

look here > http://www.ncdivers.com/phpBB2/viewtopic.php?f=7&t=4489

"Case #2. Hawaii.

"Four fisherman divers were working in pairs at a site about 165 to 180 feet deep. Each pair alternated diving and made two dives at the site. Both divers of the second pair rapidly developed signs and symptoms of severe CNS decompression sickness upon surfacing from their second dive. The boat pilot and the other diver decided to take both victims to the U.S. Navy recompression chamber and headed for the dock some 30 minutes away [the recompression chamber was an additional hour away from the dock]. During transport, one victim refused to go and elected to undergo in-water recompression, breathing air. He took two full scuba tanks, told the boat driver to come back and pick him up after transporting the other bends victim to the chamber, and rolled over the side of the boat down to a depth of 30 to 40 feet. The boat crew returned after 2 hours to pick him up. He was asymptomatic and apparently cured of the disease. The other diver died of severe decompression sickness in the Med-Evac helicopter en route to the recompression chamber." (Hayashi, 1989, p. 157) "