Texas poor standards of care

[KalipsoRed21, BSN, RN]

So after 2 years of living in Texas I think I have identified a grave issue about living in this state: A lack of medicaid.

And yes, I knew when I moved from Illinois to Texas that medicaid coverage was worse in Texas. What I didn't realize is how much worse MY CARE would be because of it. I have insurance. 
 

So in Texas everything is VERY cut throat. If you can't pay there are few resources and to try to figure out where the resources are, apply, get accepted and then find a place that accepts that charity  that will actually give care....wow, super rough. 
 

So I've been thinking the emergency departments and hospitals are just idiots in this state. I mean I've been a nurse 15 years. I have a good understanding of the plans of care and course of treatments for most complaints that come through the emergency room. I know exactly what would be ordered in most emergency rooms in Illinois. So here are 3 examples that demonstrate how different care in Texas is.

82 year old patient who had prostate ablation came in to the ED with hematuria 1 week after surgery and complaints of feeling like he is in retention. The ER did a UA and since it was negative for infection sent him home and told him to follow up with the urologist.  

I was sooooooooooo pissed about this. In any ER in Illinois we would have done a bladder scan and probably a CBC, and CMP. The patient ended up coming in to my office a few hours later, basically his whole bladder was full of blood clots. I had to irrigate for an hour to get his Foley to drain. His orthostatic BP went from 122/67 sitting to 85/46 standing. I reported the incident but was told the ER did not identify a life threatening problem so they didn't have to treat. (They didn't identify because there is no incentive for then to be thorough. They said his vitals were fine and he could urinate on his own, he had no infection.) This patient has Medicare.

Next ghastly thing I saw was a 43 y/o female who had a CT in the ER a month before. It showed a large breast mass and several smaller masses. She was at my office to try to get a breast biopsy out of pocket because Texas medicaid only covers breast and cervical cancer care. So the CT just said she had masses, she was referred to the clinic from the ER for biopsy, but because she had no insurance she had to wait yo save enough money to pay for the biopsy out of pocket. ???? She really will probably die before everything gets approved and she get any care.

My Aunt called me. She says she's been having lower back and abdominal pain for the last week and then 3 days ago she started having lady partsl bleeding. She hasn't had a period in 10 years. She is 60 and has great insurance. I advised her to call her OBGYN, but even with those complaints they couldn't fit her in for a month. I told her to go to the ER (with the full expectation that a CBC, CMP, UA, and imaging of some sort....CT or Ultrasound, should be ordered with these complaints). Yeah, no they did a CBC and a UA and told her they this is all they had to do and that she should try to call her OBGYN again. ????????

This is all they had to do. No incentive to do the best or take good care, just to do the bare minimum because there is no Medicaid to fund doing better.

Blows my mind. The system in Texas is sooooooooooooo bad, but no one here can see it. They don't know anything else. It really scares me.  Basically I am used yo better care and I believe it common practice to preform at the level things were done in Illinois. It isn't just 1 hospital in the state of Texas that does things this way, it is the way medical care is practiced in the state because there is no medicaid to apply for and back date. Because of this there is no incentive for the emergency department to do more than the most basic of testing....and even when they get a patient who has coverage, they don't think to do more because it just isn't how the emergency department practices in this state. 
 

And yes, yes, I will be looking at moving back to Illinois, but I have to get the finances together to do so. It will be at least 5 years.