Author Question: Paying Medical Bills

Carrie S. Asks:

My character’s ended up in hospital a second time! This time it’s not against his will, but the question I have is about paying for his treatment. He’s just received treatment for a broken arm, and now he needs to leave. I understand that the hospital would treat him regardless of whether he could pay, but I assume they would also do their best to make sure they were paid if possible.

The situation is this: My character does not have insurance, but he can pay, thanks to a friend. However, he doesn’t have any means of payment right now. Nor does he have an address, bank account, or any way for the hospital to make sure he pays up. What would happen? Would they just let him go and hope he was honest enough to come back with the cash?
The hospital in question is non-profit, if that makes a difference.
Jordyn Says:

Wow! Your character is definitely running into some bad luck. 

The hospital would discharge him and hope he pays at some point. If seen in the ED, they may request a copay at the end of his visit (you can’t ask for copays until the patient has been seen) but if he doesn’t have the money there’s not much that can be done at that point. We don’t hold people hostage for payment–particularly the nursing staff. It will be the billing department that ultimately follows up.
It really does not make a difference if the hospital is for profit or non profit. Each requires money to keep their doors open. Most hospitals do try to work with individuals and set up payment plans for services rendered.

Author Question: Police Response 2/2

We’re continuing with Amy’s question about police response.

In short, police are responding to a presumed intruder though the intruder thinks he’s rented the place! The genre is romantic comedy. You can read the first post here.

4. Firearms drawn?

If they are carrying long guns, then obviously the weapons are out and ready to be used. It would be typical to have their side arms drawn in this situation. It’s justified for two reasons. The first being that the man in the house called to report an intruder on his doorstep, which is felony in progress.

The second is that they know this girl and they are automatically suspicious of the man inside the home, which is also a potential felony. Felons automatically get that kind of special attention.

5. If this is plausible and the cops immediately detain the man for suspected foul play, how would they detain him? Cuffs? Secure him in the back of a cruiser until they make sure the girl is okay? Pin him to the ground?

They are going to give him some verbal commands to exit the house, come to them, face away and put his hands behind his back. They would cuff him and they would probably place him in a patrol car. They could also just sit him down on the lawn and keep a knee in his back. It’s a little more aggressive and humiliating which looks to be the goal here.

However, this guy is going to be scared and confused and he may not like the cops ordering him out of his own place (or so he thinks) at gun point. This could cause him to hesitate and/or verbally object to complying with the commands being given to him, which would result in the police using a more aggressive, hands on approach.

6. The man is holding the woman at gun point until the cops arrive, and he tells the police this when he first calls 911. It turns out to not even be loaded, and he puts it away before he the police arrive. But if the cops believe he has a gun, and he’s the one to open the door, how would they react/respond? (i.e. guns drawn, telling him to put his hands where they can see him, patting him down for a weapon? etc.)

Okay… This question may actually change some of my previous answers, especially for question number three. If the man is holding her at gun point and he has informed dispatch of this, then the cops are going to roll all the way in lights and sirens. They would probably shut the sirens off at the end of the block so they can communicate over the radio easier. Cop cars don’t have a lot of sound proofing and the sirens really do hinder listening to and talking on the radio.

Secondly, they will use their cop cars to establish a barrier or cover for themselves at the street. Other responding units are going to spread themselves out to establish a perimeter around the home. Verbal commands are going to be shouted (or possibly called out over the public address (PA) speaker on the patrol car) to the home for the man to come out with his empty hands up and he’ll be detained as previously described. Mostly likely they would cuff and stuff him in a patrol car, as the cars are now right in front of the house. The general rule of thumb is always cuff then search the suspect before putting him in the car.

Also, the cops are going to clear the house to make sure there is no one else inside. This means a room to room search of the home with weapons drawn. They are going to open all the closet doors, check under the beds, check the showers, check the cupboards, check the crawlspaces and the attic, basically anywhere a person could fit into. This would be done immediately after the man in the home is detained. They don’t need permission, they’re just going to do it.

They will ask him, “Is there anyone else in the house?” They will proceed no matter what the answer is. They will announce themselves at the front door. “This is the Police! Is there anyone inside the home? If there is anyone inside the home you must announce yourself and come to the front door with your hands up. This is the police, we are coming in the house.” Two or three cops will clear the house together so they can provide over watch of each other and maintain security of areas that have not yet been cleared.

Finally, let’s not forget that the responding officers are going to get a coded channel on the radio before arriving on scene. This means that one of the police channels is dedicated to the units that are involved in this call for service and all other normal police traffic is goes to another channel. Depending on how quickly the situation is developing, the primary police channel may be coded and normal traffic goes to an alternate channel. However, since these cops in this scenario have to travel to this location and this is not a situation that just blew up in their face, the responding officers would likely use the alternate channel for their priority traffic and all other normal traffic would stay on the primary radio channel. Some typical radio traffic would be.


Lead Unit: “3 Adam 12, I need a code on channel two.”
Dispatch: “Copy… All units stand by for a code.” A two second, high pitched tone comes over the radio. “All units be advised that channel two is code for units responding to (address). All other traffic remain on channel one.”

After it’s all over and everything is secure and safe some typical radio traffic could be:

Lead Unit: “3 Adam 12, all units are code four; you may clear the code.”
Dispatch: “Copy.. All units stand by.” They do the two second tone again. “All units the code on channel two is now clear. All radio traffic return to the primary channel.”

Many thanks to my brother, Karl, for taking the time in answering these police questions.

It’s always good to have an expert on hand.

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Amy Drown has a History degree from the University of Arizona, and has completed graduate studies in History and Archaeology at the University of Glasgow. An executive assistant by day, she also moonlights as an award-winning piper and photographer. But her true addiction is writing edgy, inspirational fiction that shares her vision of a world in desperate need of roots—the deep roots of family, friendship and faith. Her roots are in Scotland, England and California, but she currently makes her home in Colorado. Find her on Facebook at www.facebook.com/GlasgowPiper.

Author Question: Police Response 1/2

Amy asks:
I’m writing a contemporary RomCom novel, and my opening scene involves the Colorado Springs Police Department. It starts as a sort of comedy of errors when my heroine returns from an extensive trip to find someone else has accidentally moved into her half of the duplex she rents. The man she finds there thinks she’s breaking in and calls the police. What he doesn’t know, however, is that my heroine is the daughter of a former police officer who has died and is very well known by the other officers on the force.
Amy contacted me as she was needing some police help, STAT, and my brother happens to work for a police department. Even though the questions are not medical in nature, the information was too good not to post here.

What follows is the scenario and her questions– my brother’s responses are below each question.

A special shout out to my brother, Karl, for giving such detailed answers. Part II follows next post.

Amy says:

The way I have written the scene, the officers responding to the call know exactly who lives at that address because they’ve known the heroine for years, ever since she was a little girl, and are rather protective of her since her father/their fellow officer passed away. So when the man who actually called about the break-in answers the door, they immediately suspect HIM of foul play.

One officer physically detains him on the front porch while the other verifies that the girl is OK. The man is confused by the fact that the woman whom he thinks just broke into his house is on a first-name basis with the cops, and why they are so protective of her when he is the one who called them. Of course, it is all resolved when they realize the man was given a key to the wrong half of the duplex and is supposed to have moved into the second story unit.

1. Is this plausible? Might two officers who personally know the address and the occupant immediately jump to this conclusion about her safety despite the fact that the man made the call?

If the cops know this girl and already feel an obligation to protect her due to the loss of her father, then it is very likely that they would take this stance no matter what the situation is, possibly even if she were doing something wrong herself. I will say that Colorado Springs is not like New York, we’re not going to give every cop’s kid or wife an automatic pass, but they will take care of their own and they would be ultra-protective of this woman who has a stranger in her home.

2. Would two officers arrive in one single cruiser, or two separate? The scene takes place in January — what color is the typical winter uniform?

CSPD typically rides in single man cars. So if there are two cops on scene, there will be two cars. CSPD’s uniforms don’t change for the season. They wear blue shirts (short sleeve or long sleeve) over midnight blue pants. The only difference would be if they are wearing midnight blue jackets over their uniform shirts due to colder weather.

The jackets have some reflective striping on the arms above the elbow and the badges used for the jackets are embroidered patches. The cops might be wearing a mock turtle neck, or some guys still go for the outer sweaters. They are also authorized to wear plain (no logos), black, cold weather, knit caps on their heads.

3. Assuming the man calls it in as a burglary-in-progress, are two officers enough, or would more units respond? Would they arrive silent/dark, lights only, or lights+sirens?

Only two officers would typically be dispatched to a call for service like this, but more would possibly respond for a couple of reasons. First, if more are available and they assign themselves to the call, then more will show up. This is typical because a burglary in progress is considered a high risk call for service and cops like to look out for one another and catch bad guys.

Second, if this girl is so well known within the department, anyone who can respond, probably would. It may be a way for the author to really drive home the girl’s popularity or the sense of protection the department has for her, when six cops, a sergeant and a shift lieutenant all show up on scene. The police would respond lights and sirens, but the rule of thumb is to shut that stuff down several blocks away. If it is after dark, they may role down the block blacked out and no matter what time of day it is, they will park two to three houses away and walk in. One or two them could pull out some long guns too (shotgun, patrol rifle).

Tune in next post for the remaining questions.

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Amy Drown has a History degree from the University of Arizona, and has completed graduate studies in History and Archaeology at the University of Glasgow. An executive assistant by day, she also moonlights as an award-winning piper and photographer. But her true addiction is writing edgy, inspirational fiction that shares her vision of a world in desperate need of roots—the deep roots of family, friendship and faith. Her roots are in Scotland, England and California, but she currently makes her home in Colorado. Find her on Facebook at www.facebook.com/GlasgowPiper.

Author Question: Jack and Jill

Maisie asks:

My 16 year old female main character is going to jump down from something (akin to jumping from a tree branch), the ground below is pitted and sloped though, and I need her to get injured. In my mind, it would be her ankle or her wrist (from catching herself) with some minor lacerations to her face. I’ve never broken anything to know how it feels. I want the medical scene that follows to be realistic, her Mom will meet her at the hospital, it’s late at night.

What would be the steps, the healing process, pain management, any specialists, and healing time. I want her to be injured, but I don’t want her to be crippled for the entire summer (length of the novel). I want to know how the hospital scene and future doctor appointments will go, what they’ll look for, and how this is going to encumber her in her regular life





Jordyn says:

The thing to know about ankles is that they rarely fracture. 95% of the time, they are sprained. For a sprained ankle, an air splint (crutches if the patient can’t bear weight) for 7-10 days and then the patient should work themselves out of the splint at that point. If still painful– they should follow-up with their regular doctor or orthopedic doctor at that time.
It’s more likely, with your scenario of falling down a hill, for a simple break to the lower forearm.

Treatment in the ER will be x-ray to evaluate for fracture, pain medication (usually Ibuprofen suffices). These would be the same initial treatments for an ankle injury as well. If fractured, the patient is placed in a splint and NOT a cast.

Pt will follow-up with ortho in 7-10 days for cast placement. Cast is on for 4-6 weeks. There shouldn’t be any permanent damage.

Lacerations: Generally a topical numbing agent is applied. This sets in place for 20-30 minutes. Or, the patient is directly injected with Lidocaine. Wound is irrigated with normal saline. Stitched up. Antibiotic ointment over the stitches. Wound should be cleansed twice daily with mild soap and water then Neosporin or equivalent over top. Stitches to the face are usually removed in 5-7 days. Tetanus shot if the patient hasn’t had one in the last five years.

Author Question: What is a Good Condition for my Character?





Teena asks:

I want my main character to have a medical condition his girlfriend is unaware of. It needs to incapacitate him and put him in a bit more jeopardy when he doesn’t get his meds. I also want him to have a concussion so he black outs once or twice while he’s with the bad guy. But he also needs to escape.

A little earlier in the book I want him to exhibit some symptoms to his girlfriend but without revealing his condition…maybe watching what he eats, and in another scene exhibiting dizziness and weakness to a friend but claiming he’s just out of shape. Then, a little later, while he is by himself working on his novel, maybe some shaking where he takes pills and readers don’t know why. They may just think he’s an addict.

He is not obese and is in his early thirties. Which is counter to the profile for most type 2 diabetics I think.

Any suggestions?

Jordyn Says:

Thanks for sending me your question.

I don’t think Type II diabetes is a good option considering his age and good health status.

Here are a few posts I did specifically on diabetes:

1. http://jordynredwood.blogspot.com/2011/07/diabetes-part-12.html
2. http://jordynredwood.blogspot.com/2011/07/diabetes-part-22.html

Off the top of my head– I might consider some type of cardiomyopathy. Where he needed digoxin and lasix as maintenance meds. If he came off those– he could definitely be symptomatic. A lot of the criteria you want would fit this type of condition.

1. What is cardiomyopathy: http://www.nhlbi.nih.gov/health/health-topics/topics/cm/

2. Cardiomyopathy: http://www.nlm.nih.gov/medlineplus/ency/article/001105.htm

3. Cardiomyopathy: Treatment and Drugs (and lots of other info): http://www.mayoclinic.com/health/cardiomyopathy/DS00519/DSECTION=treatments-and-drugs

Read through these resources and see if they strike a chord.

Teena Says:

Thanks so much for the suggestions. I think maybe the hypertrophic
cardiomyopathy is the way to go!

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Teena Stewart is a published author, artist, and ministry leader. She is currently working on a sequel to her first completed romantic suspense novel. Recent published books include Mothers andDaughters: Mending a Strained Relationship and The Treasure Seeker: Finding Love and Value in the Arms of Your Loving Heavenly Father. For more info visit www.teenastewart.com and
http://nearly-brilliant.blogspot.com/

Author Question: Major vs. Minor Organs

When I first got this author question, I thought, okay– this should be really simple. A major versus minor organ– easy right?

Until I started to think about it.

What I would consider the major organs would be the brain, heart and lungs. Then I began to think about some of the minor organs (liver, stomach, etc…) that become very problematic if they aren’t functioning correctly causing major problems for the patient.

 
Then I thought– this isn’t really a distinction I make in medicine. For instance, it’s not a term used on a daily basis. So, then I wondered if someone did use that type of terminology.
 
On with Dee’s question.

Dee Asks:

I’m wondering if/hoping you could answer a quick question for me…

Is a spleen considered a major organ? Or not so much because it’s not vital to the body?

Jordyn Says:

Not sure how I would answer. Why is it important to make the distinction?
This isn’t a distinction we make in medicine.
Maybe this explains my difficulty: http://www.anatomy.org/content/how-many-organs-no-matter-how-minor-it-does-human-being-have-and-what-are-they

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Dee J. Adams is the author of the Adrenaline Highs series published by Carina Press. Her first book, Dangerous Race, was a finalist in the 2012 Golden Quill Contest. Adams also has the distinction of being hired by Audible.com to narrate Danger Zone and Dangerously Close. Living Dangerously will be a May 2013 release. New York Times bestselling author Suzanne Brockmann says: “Dee J. Adams delivers it all in Danger Zone: romance, intrigue, and a cast of characters to fall in love with, authentically set in the gritty and entertaining world of movie-making. This one’s on my keeper shelf!” You can connect with Dee J. via her website: http://www.deejadams.com/

Editor’s Question: Consent for Rape Kit in Unconscious Victim

During my blog tour for Proof I had an interesting question from fiction editor, Ramona Richards, in the comments section of the blog on this post that dealt with collecting a rape kit.

Ramona: If a sexual assault victim is stable but unconscious– will the medical team do a rape kit and if so– who do they get consent from?

Jordyn: This is an interesting question on many levels. As a nurse, I’m first an advocate for the patient but also as a nurse and woman– I want to see justice happen for this woman as a victim.

The central issue is that part of the rape kit is very invasive. Particularly the pulling of the hair from the head and groin area and well as the internal pelvic exam.

No one wants to put a victim through something more traumatizing– so generally– permission must be given by the victim in order for the exam to be done.

But say– the victim looks like she is not going to wake up to give that permission?

Part of the exam can be done. External evidence and swabs can be collected. An external exam of the vaginal area could also be done. Pictures can be taken.

Likely– we’ll wait to see if the patient wakes up. Nothing should be disturbing the internal presence of the evidence if the patient is hospitalized. Exams should be done within 72 hours and one nurse practitioner I work with said semen could be preserved on the cervix for 10 days.

But what if it looks like the victim is never going to wake up?

Then it becomes an issue for the courts. They would have to issue an order for the exam to be done. So either the victim has to give permission (and no– not next of kin)– or the court would order the exam to be done.