Send the Bill to Rick Perry

The disturbing story of a brain-dead pregnant woman in Texas ended mercifully last week after a judge ordered her removed from life support despite a state law requiring the hospital to keep her alive. But there’s one big question remaining: Who has to pay for the nine weeks of hospital care that the family did not want?

On Sunday, Marlise Machado Muñoz — the brain-dead women who was forced to remain on life support against her family’s will because she was pregnant — was disconnected from a respirator after a months-long battle with the hospital that was caring for her. John Peter Smith Hospital finally agreed to relinquish her body to her family after a judge ordered it. Now, her husband Erick is finally beginning the process of saying goodbye to Muñoz and her unborn child, who he named Nicole.

But in the aftermath of the family’s personal tragedy, there are still some unanswered questions. It’s not guaranteed that Texas will actually change the arcane state law that allows hospitals to override women’s end-of-life wishes if they are pregnant. And it’s unclear who exactly will be responsible for paying the medical bills that resulted from Muñoz’s hospital stay, which stretched on for about nine weeks.

In an interview with CNN’s Anderson Cooper, Erick Muñoz acknowledged that he has been receiving medical bills at his home — although he’s not sure exactly what he will be expected to pay.

“They have not come to me and said how that’s going to work,” he told CNN. “But I believe I’ve heard several media outlets…saying that they’ve asked about that. They have asked that question. They said they would continue normal billing.”

9 weeks in ICU almost certainly runs well over a million dollars and the family damn well shouldn’t have to pay it. I say send the bill to Rick Perry.

35 comments on this post.
  1. colnago80:

    I dont want to play lawyer here bu somehow I don’t think that Mr. Munoz would have much trouble finding a competent attorney who would be willing to take on the hospital on either a pro bono or contingency basis if he chooses to contest the charges that were rung up after his wife was declared brain dead. However, any attorneys (i’m looking at you Ben P or John Pieret) who post comments here occasionally may wish to comment on this.

  2. jamessweet:

    Could it be? Yet another problem that would be solved by single payer? Just sayin’…

    (Not that it would have solved the other, bigger issues, but…)

  3. doublereed:

    FISCAL CONSERVATISM!!!

  4. noastronomer:

    ” the family damn well shouldn’t have to pay it.”

    Damn right. I don’t know who does, but I know who doesn’t.

    Frankly I think the hospital should eat it. Maybe that will encourage them to hire better staff.

    Mike.

  5. Olav:

    Apart from the questionable medical decisions and the problem of who is paying, this:

    9 weeks in ICU almost certainly runs well over a million dollars

    is a huge problem by itself.

  6. D. C. Sessions:

    Simple process of elimination:

    * The State of Texas isn’t liable for actions taken to comply with its laws. Off the hook.

    * The Muñoz family isn’t paying, if for no other reason than that they haven’t got it.

    * The Muñoz family’s insurance has a pretty good shot at refusing to pay because they only cover living people.

    * Which leaves the hospital and doctors, who will pass the charges on to patients who aren’t covered by any sort of negotiated cost arrangement (in other words, uninsured.)

  7. dingojack:

    Why should the hospital be out of pocket for following the law? Send the bill to the jackass(es) who wrote, voted for and signed into existence this idiotic law, plus penalties for late payment, of course.
    Dingo

  8. eric:

    The State of Texas isn’t liable for actions taken to comply with its laws. Off the hook.

    In this case, didn’t the judge find that the state law was unconstitutional? In that case does your point hold?

    Otherwise, a State could pass blatantly unconstitutional laws, force their citizens to follow them for a limited time while it winds its way through the court system, then get off scott free. “Bob, congratulations, you’re a slave and will continue to be a slave until the case goes to court. Which we will slow roll. Then when the courts release you, we owe you nothing ,having extracted your labor for free and made your life hell for a few years.”

  9. dingojack:

    I also have to ask:
    And what if the woman slipped into a diabetic coma? If the woman’s parent’s were Seventh Day Adventists*, you’d be perfectly fine with the family pulling the plug because of their ‘arcane laws, despite the medical professionals knowing that she could be saved with insulin? Sometimes doctors should get to decide, not the families.
    Dingo
    ——–
    * even if she wasn’t

  10. colnago80:

    Re eric @ #8

    The state might also argue that the hospital misinterpreted the law and that they should be suing their lawyers for malpractice.

  11. Sastra:

    This is really a non-problem. I’m sure that even now all the Right-to-Life organizations in Texas are passing around one of them big ten-gallon hats they have out there, the members generously digging into their pockets to show support for the state’s sensitive concern for the deformed, doomed fetus.

  12. matty1:

    Maybe there should be a law stating that if a law is found to be unconstitutional the legislators who voted for become personally liable for associated costs. Of course it would never pass but if it did exist might it improve matters by making them think twice about what they support?

  13. dingojack:

    So in Texas you can pay a $1,000,000 or more penalty for following the law?
    Ah America, the home of brave and the land of the fee.
    ;/ Dingo

  14. raven:

    The State of Texas isn’t liable for actions taken to comply with its laws. Off the hook.

    In this case, didn’t the judge find that the state law was unconstitutional? In that case does your point hold?

    The judge did no such thing.

    He ruled that the law doesn’t apply to dead people. This woman was legally dead.

  15. Alverant:

    DC has a good point, if the hospital pays it will do what any business does and pass the costs of their mistake onto the rest of us. Also I’m not sure if the hospital was following the law or following the religious beliefs of its directors. If it’s the latter, then the directors should pay. In any case, a person shouldn’t have to pay for something they didn’t want.

    @jack you’re comparing apples to oranges. The woman was already dead. That wasn’t going to be fixed by a quick shot. Let’s use some common sense. The fault is with those who made the decision to keep her pseudo-alive and then expect to be paid for it.

  16. dingojack:

    Sastra – Is there any evidence justifying: ‘the deformed, doomed fetus’?
    Curiously,
    Dingo

  17. dingojack:

    Alverant – perhaps you need to re-read mine #9, especially the last sentence. Then get back to me.
    Dingo

  18. raven:

    @16

    Brain Dead Marlise Munoz’s Fetus Is ‘Distinctly Abnormal’ Say … – Time
    nation. time. com/…/attorneys-brain-dead-womans-fetus-is-distinctly-abno…‎

    Jan 23, 2014 – A fetus being carried by a brain dead Texas woman against her family’s … “Even at this early stage, the lower extremities are deformed to the …

    1. Yes, the fetus was deformed and probably nonviable. The lower extremities weren’t really even there. There was evidence for hydrocephalopathy, and possible heart irregularities.

    2. You probably can’t blame that on the state of the incubator i.e. dead though. There is a very small database of similar cases. I”m going from memory here but about half result in normal birth, half don’t make it for one reason or another.

  19. cptdoom:

    If the hospital does try to stiff the family, can’t they sue for damages resulting from the deliberate desecration of a dead body and an unwanted interference into a religious practice (namely, burying the dead with some dignity)? I am sure there are plenty of lawyers who would be more than happy to take that case on.

    Sastra – Is there any evidence justifying: ‘the deformed, doomed fetus’?

    It was widely reported that the fetus, having been deprived of oxygen for an undetermined amount of time, and thereafter developing in a corpse, was seriously deformed, including hydrocephalus and lower extremities that were so abnormal the fetus’ gender could not be determined. The medical opinion was that the fetus, assuming it actually survived long enough, would not be viable.

  20. eric:

    Matty1

    Maybe there should be a law stating that if a law is found to be unconstitutional the legislators who voted for become personally liable for associated costs.

    Executive branch civil servants can already become personally liable if they knew or should have known that some on-the-job action they are doing is against the law. However, proving “should have known” is a big hurdle and courts are generally pretty conservative (i.e. giving the civil servant much benefit of doubt).

    Raven:

    The judge did no such thing.
    He ruled that the law doesn’t apply to dead people. This woman was legally dead

    Thanks for the correction! Back to D.C. Sessions’ question, I could see how this could leave the state liable for costs because the situation could be construed as the state giving incorrect legal advice to the hospital. I.e., ordering it to treat a dead person under laws only designed for living people.

  21. dingojack:

    OK I see* …. in that case….
    Still can the hospital be liable for providing, in good faith, a service (no matter how unwanted by the family) to comply with State law? Can one take money off them for doing something that, at the time the cost was incurred, was perfectly legal for them to do , and can this be done without some kind of due process?
    Dingo
    ——–
    * But consider the source

  22. raven:

    huffpo: from Hungary Nov 2013

    The woman’s family and doctors had to make a choice: Should they keep the mother on life support so the 15-week-old fetus would have a shot at life? The answer was yes, and three months later the baby boy was born to a brain-dead mother at 27 weeks.

    Delivered prematurely via cesarean section in July, the baby boy weighed in at 3 pounds, 2 ounces. Physicians at University of Debrecen Medical and Health Science Center announced the unique birth Wednesday and said the infant is healthy and home with his family, the Agence France-Presse reports.

    and

    In 2005, a Virginia woman, who was declared brain-dead when she was 15 weeks pregnant, was also kept on life support for three months. A baby girl was born to the brain-dead mother at 1 pound, 13 ounces, though the infant did not survive past six weeks.

    FYI.

    When I first heard about the Texas case, it seemed improbable.

    It turns out though that sometimes brain dead women can give live birth. And sometimes it doesn’t work. It seems to be about half and half. There have been very few cases, maybe two dozen or so.

  23. Drew:

    @dingo

    More over, does the judges ruling that the law doesn’t apply to dead people, mean that the actions taken by the hospital were never legal in the first place? If so, then the hospital would be the only liable for the cost, no?

    Afterall, it’s neither the family’s nor the state’s fault that the hospital’s lawyers didn’t know how to read the law.

  24. Synfandel:

    And as with everything in the US, the lawyers get richer.

  25. dingojack:

    Drew – ‘in good faith’*.
    Dingo
    ——–
    * (unless the law specifically says ‘oh by the way, this in no way applies to dead people’ I can’t seem to get Ed’s link to work).

  26. Wylann:

    Raven, the number I remember (disclaimer, it’s me memory….) was only 2 out of 19 even survived (or maybe were normal), but anyway, it was very low.

  27. raven:

    @26

    bioedge web site:

    However, surprising as it may seem, there have been a small number of documented cases of brain-dead women who have given birth to viable children. A 2010 study by German doctors examined 30 cases of brain-dead pregnant women between 1982 and 2010. Twelve viable children were born and survived infancy.

    I had to look it up. Relying on my memory isn’t always a good idea.

  28. Michael Heath:

    I recall the hospital was following the dictates of the prosecutor until the judge’s order was delivered. That’s because it’s a state-owned hospital. I bring this up because a bunch of comments here frame this in a way that insinuates the hospital is a private entity when it is not.

  29. Moon Jaguar:

    This may be a distinction without a difference, but wasn’t the fetus on life support, not Ms. Munoz? One can’t provide life support to a corpse.

    The news stories state that life support was withdrawn from Ms. Munoz, a convention that understates the unnatural horror of the situation.

    Regardless, the consequences of foolish laws passed by are rarely suffered by the politicians who pass them with fanfare and chest-pounding. My heart goes out to Erick Munoz who has to deal with this bullshit while grieving his tragic losses.

  30. Jeff D:

    Let’s assume that Mr. Munoz signed admission paperwork for his wife, including an “informed consent to treatment” document on her behalf, when she was first rushed to the hospital. Let’s also assume that he signed the part of the forms in which he agreed to be responsible, as “guarantor” for the patient (Mrs. Munoz), for the costs of subsequent treatment.

    Based on my admittedly minimal previous experience, as a patient and as a lawyer, with hospital billing disputes, it does not follow that Mr. Munoz is responsible at all for any of the bills that were generated by the hospital after the hospital decided to keep Mrs. Munoz’s corpse oxygenated and her organs on artificial support (“life support” is entirely the wrong phrase).

    After Mr. Munoz made it clear that he did not want to continue to have his wife’s corpse kept oxygenated by means of machines, and after the hospital could see that she was brain-dead, Mr. Munoz’s previous consent to be billed and to pay was no longer in effect. At least, that’s the argument that I’d make if I were a Texas lawyer (instead of an Indiana lawyer) and if I were defending Mr. Munoz in a collection lawsuit by the hospital or its agent. There was a failure of consideration after the hospital decided to keep Mrs. Munoz’s body hooked up to those machines without any (renewed) informed consent from her husband.

    The most likely outcome is that the hospital will end up writing off the bills, or the portion of the bills that result from the hospital’s unilateral “treatment” actions against Mr. Munoz’s objections. The hospital voluntarily took a stupid, stupid position with no reasonable basis in law, and the finacial risk should be the hospital’s. If the hospital did sue Mr. Munoz, it would be interesting to see if his lawyer woudl demand a jury trial. How would you like to be representing the hospital, as a plaintiff, with the task of convincing 6 jurors (even 6 average Texans) that the grieving husband should pay the bills for ‘treatment” that the dead wife arguably did not want and that the husband opposed?

  31. D. C. Sessions:

    The fault is with those who made the decision to keep her pseudo-alive

    A perfect real-world application of the word, “undead.”

  32. Stacy:

    This may be a distinction without a difference, but wasn’t the fetus on life support, not Ms. Munoz? One can’t provide life support to a corpse.

    Well, yes, one can provide life support to a corpse. A brain dead individual’s body can be kept alive on life support. Vital organs other than the brain continue to function: the heart beats, the lungs breath, the body excretes. This is commonly done with organ donors; support is used to keep the bodies alive until the organs are harvested.

    I’ve read that it’s very tough on the nurses and technicians who have to tend to the “neomorts.”

  33. Stacy:

    (My comment was in reply to Moon Jaguar, #29.)

  34. jenlanglois:

    @dingojack, SDAs have no objection to medical treatment. You may be thinking of Christian Scientists.

  35. jenlanglois:

    It turns out though that sometimes brain dead women can give live birth. And sometimes it doesn’t work. It seems to be about half and half. There have been very few cases, maybe two dozen or so.

    Would be interesting to know what those other women at 15 weeks of pregnancy died from. Did those other fetuses go without oxygen as long as this one was believed to have gone?

    In the other study with 30 brain-dead women, where 12 gave birth to living babies, it would be interesting to know how far along the pregnancy was when the woman died. Were those 12 mostly babies who were a week or two from viability?

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