If We Had Some Bacon

My dad used to have a saying that went like this, “If we had some bacon, we could have bacon and eggs, if we had some eggs.”

I don’t know why, but today’s experiences in The Regional Hospital made me remember his humor. Certainly you have to keep a sense of humor to get through the bureaucracy in all organizations. A little more humor is required when there are language and cultural barriers that keep getting in the way.

With that lead-in, let me share with you my new experiences from today.

First let me say “Thank You” to the two blood donors that gave blood this morning. The Boquete Hospice and Health Foundation had one donor and another came as a result of one of my other requests. You do not realize how important it is to have a source for blood in case of an emergency.

Panamanians have plenty of family that can be organized on a moments notice. Foreigners don’t have that luxury.

There are multiple facets that I want to cover, so this post may be a little disjointed. I’m sure those that follow my blog may be thinking that this isn’t new and all posts are a little disjointed. Oh well.

Today’s events are related to the U.S. citizen that was transferred from Hospital Chiriquí to the Regional Hospital for a spinal operation. You may remember my post related to researching the use of Tri-Care that finally resulted in the Regional Hospital being the only option.

Then there was the admitting error, which neglected to record that the patient was diabetic and the difficulties getting the chart updated. After about three weeks in the hospital, all hurdles had been handled and the appliances for the spinal surgery were in the process of being ordered.

Prior to the order being executed, the hospital said the back surgery couldn’t be done because of a circulation problem that had arisen in the patient’s right leg. The non-diabetic diet the patient had been on for three weeks probably hadn’t helped the situation.

Last week, I talked to the nurse’s desk and learned that he was scheduled for surgery to remove the leg, but that was on hold for blood and paperwork. That prompted my request for blood donors. Today, I better understand the paperwork problem, which I will get to later.

Today, my Embassy letter didn’t work it’s magic and I was not allowed to go to the patient’s floor to check on the surgery schedule. The guard insisted I needed to talk to the Hospital Director first. OK, hurry up and wait for the Director to arrive.

After about 10 minutes, the Director arrived and I asked why the leg surgery for the patient had not happened, because I had been told last week it was to happen on Monday or Tuesday and I was now told it was being held up for 2 units of blood.

The Director said it should not have been held up for that reason and called the head of the floor the patient was on. The Director asked about the operation and was told it could be done now. I can feel my hand searching in my pocket for an aspirin to ward off a headache.

While I was there, I brought up the fact that this patient had been admitted with the admission records indicating he was not diabetic. The operation that was being scheduled was for a diabetic problem and I was concerned that the hospital’s procedures for patients that did not speak Spanish, might have aggravated the problem.

I told him I am always available to help, if there is a difficulty in situations like that. He took my card and dictated a memo, on the spot, asking all floors to contact me when they run into English language problems with U.S. citizens.

With that solved, I went back to wait on the two donors. I got a call and one of the donors had already gone to the blood bank and was having “paperwork” problems. I said I would be right up. The blood bank is on the second floor.

The donor had given the patient’s name and hospital number as I had posted in the donor request. However, the hospital had the patient’s name wrong on the computer and the donations couldn’t be given without identification documents for the patient. Luckily, the son had told me to keep the passport, so I left to go home to get the patient’s passport.

We had also been told that there was a cutoff of 10:00AM to get the blood donated. It took me about 15 minutes to get the passport and return. The attendant was now happy and the donors were being processed. The attendant told me to have a seat.

She then gave me a receipt. I thought it was the paperwork that needed to be delivered to the patient’s floor to get the surgery started. I signed as requested and then looked at it. To my surprise it was a bill for $230.86. I said, I hoped they didn’t expect me to pay that bill. She said, “Of course”. I told her I was not a family member and it should just be added to the patient’s account.

She said this bill had to be paid for prior to surgery or the blood could not be allocated to the patient. I asked what the charges were because the donors were providing the blood. Apparently, the charges were for the testing of the blood prior to it being accepted.

My hand goes in my other pocket searching for another aspirin. I asked how we were going to handle this, since I could not and would not pay. Another doctor from the blood bank came out to help resolve the problem. He told me to take the bill down stairs, pay a small amount ( a couple dollars) and they would stamp the receipt and bill the government for the balance.

Well, that probably works for Panamanians with a social security number. I go down stairs and the lady in the office told me it had to be paid in total and “Right Now”. I told her I was not the family. She said the family would have to come pay it. I told her the family was in the US. She sort of shrugged her shoulders. I told her I would call the U.S. Embassy and for her to explain it to them, because I didn’t understand. Hand goes in pocket again ( I must have an aspirin somewhere).

I call the Embassy and explain my difficulty and asked if they would talk to the lady. I tried to hand the phone to the lady and she refused to talk to the Embassy. My contact said she would call the blood bank.

The lady finally said she would write up a credit slip for me to sign and we could move forward. OK. whatever it takes. I am out of patience and have no aspirins.

She then adds up the receipt, I had brought from the blood bank, and informed me that they had added up the numbers wrong. It was not $230.86, but really $231.86. She sends me back to the blood bank to get a corrected receipt.

Luckily the blood bank is on the 2nd floor and not the 4th floor. With the corrected form in hand I go back to my new friend in the cashiers office. She had two other people in front of me. I got to the window and she accepted the form, had me sign two more documents and gave me a pink receipt to take back to the blood bank.

I am sure I am on hook to pay for this bill sometime in the future, but first things first. Let the operation begin.

I decide to go back and talk to the Director to better understand the $231.86 and how that aids the hospital in getting blood donors. He was in a meeting for a couple hours.

I decide to put that conversation off to another day. Instead, I go to another area to talk to a lady, I had met a few weeks ago, that works in one of the administrative areas of the hospital. I brought her up to date on today’s events. She called to check on the surgery schedule and found out that the operation was in progress.

I will call her a little later to get an update on the patient’s condition.

There are a few lessons, I learned from this.

First and foremost, I need to remember to carry around a couple aspirins.

Second, I need to relax and keep the type “A” personality from taking control, when frustration starts raising its head. Headaches can occur.

Third, if you don’t give up, you can eventually make things happen.

I should point out before closing, that these experiences are not limited to gringos. It is not some evil plot to make us want to leave this beautiful country. The exact same thing happens with Panamanians. They just accept it better and are never surprised with any barrier placed in their way.

Keep your fingers crossed that the patient does well in the operation.

UPDATE: I just received a call and he is back in his room. The surgery is supposed to have gone well. I will check on him tomorrow.

29 thoughts on “If We Had Some Bacon

  1. Don, I cannot help but think the headaches you experience will prevent future headaches for people who will experience a similar situation in the future.
    I was one of those who was contacted to donate blood for this patient. Unfortunately, I donated blood just one week before and I was not eligible. I appreciate knowing someone else was able to fill in for me. Thank you for your important insights and updates.

  2. Don first of all don’t call yourself a gringo it is putting yourself down the historical meaning of it is adjective doesn’t apply OK. Second their is the same problems here in Illinois just visit Cook County hospital and we talk. Third aspirins are for pain your localized pain may come from the word hate alone. Finally, I don’t think so, anyone want to make you or USA citizen leave, Panama has always welcome the USA people, so be thankful that you are there and for the future learn to connect with the right people, email me I told you my family are doctors and lawyers. David is a great land, friendly, people, but don’t expect just because you say you are american they are going to drop all, there many other patients there, in dear need of attention. Here in USA is the same for me and my son. Chill out and thank God so you will receive more kindness and help from above.
    Good luck!

  3. Don Ray, Good on you. You certainly have more
    patience than I do. Thank you for all of your good deeds and good work.
    You are storing up bonuses that will help you get to heaven.

  4. Don Ray, I have had similar experiences at the Regional Hospital, with the hospital trying to get the donors to pay the expenses of the blood draw, tests, and administration of the blood to the patient. You did the right things. I’m so glad he got his blood and surgery. I hope he does well. I think that there always needs to be someone like you with the donor to get through the maze. Thanks for all you did today. Mary Lynah, Blood Donor List Coordinator, 6533-0967

  5. You say that we xpats need to help each other, as we don’t have extended families here. But nost of us are of retirement age, and I understand that we are not allowed to donate blood because of our age. True?

  6. There are requirements that have to be satisfied to donate. That is true. I understand the requirements in the Regional Hospital are more strict than the others. That is only hearsay on my part, because I don’t know that for a fact.

    What I think you need to take out of this is to have a plan for a potential problem. If you think that is a problem you can’t deal with, then you have choices to make. Panama is not going to solve the problem for you.

    Many that move here become enough of the community that the community will take care of them in a time of need, and become their extended family.

    I think all other hospitals also have donors lists. I know, I had names of four Panamanians with A+ blood that I was prepared to contact. I think the fire department also has a list.

    I can only document the situations I have run into. How similiar situations may affect others is for them to decide.


  8. WOW….how would they handle an American or other that had a heart attack?
    Patient would die before the paper work was done correctly.
    Any updates on 911 and ambulance services in Boquete and David surroundings.

  9. I am sorry to read about all the difficulties you have been dealing with in this particular case. No personal offense intended, but having a Type A personality and living in Panama can be a precursor to heart disease. Sometimes a different approach work best.

    Paying a small amount for the bill as suggested by one of the doctors was the least expensive way of dealing with the bill. What usually happens is that the patient is reclassified as “indigent” or “person of limited resources”. The small amount that the Hospital was asking you to pay is very insignificant compared to the overall cost of the patient’s stay in the hospital. I once assisted a Panamanian gentleman who needed emergency surgery. This man had no family or the financial resources to pay for the operation. After explaining to the doctors about the man’s situation, I was referred to the Hospital’s social workers. At the end, the bill came down to the amount of fifty cents! I just had that kind of money in spare change in my truck’s ashtray. The System paid for the balance. This gentleman had never paid a penny into the social security system, but that did not mean that he could not get the necessary care. I must admit that this incident took place a few years ago. I am not sure how a similar situation would be handled now days, but from your post I deduce that it is still the same.

    There is a very interesting fact that perhaps is not widely known. The health care provided in hospitals as the Regional is mostly subsidized by all the Panamanians paying into the Social Security System. Those who have never paid into the system will be charge for most of the services. When the CSS was introduced in Panama, it was a complete separate system dedicated to take care of those who paid into it. The care was excellent! At one point somebody had the great idea of integrating The Ministry of Health and the CSS into one single system. Of course, it was never the same after that.

  10. To cover one point you raised. I did offer to pay a small amount on the bill and that was rejected by the lady I was talking to. She would only settle for “ALL”.

  11. My God, Don. You have the patience of Job!!! I think instead of the aspirins you need to carry around a flask of Abuelo. My neighbor, a former Marine, entered Hosp. Chiriqui to have some old shrapnel removed. They did the job but left an instrument in his stomach. He went back complaining about stomach pain, ran some tests, operated and removed the instrument. He was then presented with a bill for $3000. This was what he told me and I have no reason to doubt him!!!

  12. I have no doubt that you offered to pay a small amount on the bill, and of course the lady at the office was going to demand full payment before moving anything forward. It is her job to collect all the monies due. But the decision to change the patience status and have the System absorb the cost of care is definitely above her pay scale. This has to be handle by Social Services at the hospital. Get in touch with the social workers, explain the situation, and ask if there is any way they can help in this case. If they indeed determine that the patient can be consider “indigent”, the matter will be resolve. If not, this gentleman will be responsible for the bill. Good Luck!

  13. No one asked for the bill to be placed on the Social Security. I asked for the cost to be placed on the Patient’s bill to be settled by the patient or family upon discharge.

    My offer to pay a portion up front did not imply that nothing more would be paid. I only offered to do that at the instruction of the hospital staff. I always thought it should go on the patients bill.

    All other patient expenses are going on that bill. Why not blood? What is the difference between all the IVs that have been used and blood? The patient isn’t asked to pay for those as they are used. They are put on his bill daily.

    What about his daily meals. Other blood tests?

  14. As I followed your postings about this particular case, it was my perception that the patient was unable to take care of the bill. My apologies for my failing to understand what the issues were.

    Earlier today I contacted the Blood Bank at Regional Hospital seeking for answers to your questions. The official in charge explained to me how the Blood Bank operates.
    In Panama, a blood bank is a separated entity from the hospital or clinic where it is located. It has its own operating costs, billing procedures and staff. They are regulated by very strict laws and international conventions designed to keep the blood supply free of contagious pathogens. Since trading on blood is illegal in Panama, most of the blood supply comes from regular donors who receive no compensation. The blood is available at no cost to those who need it. In some cases when a particular blood type is not available due to its rarity, the patient is billed for the supplies and personnel necessary to collect the blood. That is also the case if you want to store at the bank your own blood supply or when a patient requires more blood than the bank has in storage. This billing is independent from the cost of medical care. When the bill cannot be paid in full, the patient can make payments until the debt is satisfied. The hospital’s cashier office only acts as an agent in the collection of any payments. I do not yet have an answer to why the cashier demanded full payment. I will get back to you once I figure this one out.

    Panama has 61 strategically located blood banks with a computerized list of donors. How ever, no all the potential donors or blood types will be found in that list. Blood donation in Panama is strictly voluntary and blood shortages is a never ending problem. As you suggested in your post, those who chose to move to Panama should planned ahead for this type of contingencies. If somebody has a rare blood type is probably a good idea to put together a list of potential donors and have it entered in the Blood Bank’s database. Being unconscious on a hospital bed and in desperate need of a blood transfusion is not the right time to go and look for donors. Besides, there may not be a Don Ray around to help either.

    I found some sites in the Internet with information about the Blood Banks in Panama. Just enter “bancos de sangre en panama” in the search window. They are mostly in Spanish but I am sure an English version can be found.

  15. Hi David. All very good information. I surmised that the blood bank was probably a separate entity, however, it would be a huge improvement, it the relationship between the entity of the hospital and the entity of the blood bank were improved.

    When a the individual is a patient of the hospital and has a patient number, then there is a logical place to direct the bill for the blood.

    Demanding that donors pay a fee for testing, which was stated as happening above, is not conducive to people wanting to donate. So either there is a communication problem between English speaking donors and Spanish speaking staff ( easily the case) or the process seems flawed to me.

    Still, you have done an excellent job of adding some clarity to the situation.

    Thanks for taking the time to leave your comment.

  16. If trading in blood is illegal in Panama, then the bomberos are breaking the law frequently. They charge up to $100 per unit when there is no other supply. Panamanians and gringos both use this supply of donors, especially at the private hospitals where there is no blood bank.

  17. what are or where can one get the donation requirements in panama. I am type O+ a universal donor, so I can give to anyone if they accept me as a donor.

  18. The website for hospice, http://www.boquetehospice..com has a button on the main page for blood donation. Click that, and you will get the requirements for Chiriqui Hospital. The requirements vary a bit at the other hospitals, but Chiriqui is most commonly used. Call me at 6533-0967 with any questions. BTW, O negative is the universal donor, although O pos can give to many people. O Pos cannot give to O neg, so it is not used in situations where the blood type is not known. Mary Lynah

  19. Trading in blood in Panama is indeed illegal! However, due to a loophole in the law, no provision was made to punish such trading. Buying blood from non properly screened donors is a very risky business according to the Blood Bank officials. Blood banks in Panama follow a very strict protocol when collecting blood. Since making a profit is the main motivation for these individuals they have no reason to disclose in detail their health background. That blood may not be free of pathogens and the hospital may not conduct the necessary tests to guarantee it. A safer alternative would be to take the donors to the nearest blood bank, pay all the necessary fees, have the blood bank to process the blood, and then have the blood transfer to the clinic or hospital taking care of the patient. This may not sound easy, but is possible.

    Law #17 of the Panamanian Health Code, issued on July 31, 1986 and Resolution #374, issued on Sept. 7, 2001, regulate the blood banks and blood transfusions and also establishes the protocols to follow for the donation and collection of blood in Panama. Panama adheres to international protocols which are the same as the ones followed in the USA , Canada or Europe.

    As to why a fee was demanded from the donors for testing, the rationale behind this practice is that the donation is being made to the patient and not to the blood bank. The Blood Bank is only acting as the processing agent for the blood. The blood belongs to the patient and therefore it cannot be allocated to anybody else. The patient and the donors are responsible for the costs associated with the processing of the blood. When the blood comes from donors who donate the blood to the bank to be made available to the general population, then any expenses are absorbed by the bank.

    When it comes to the billing, the collection procedure could not be easily explained. Although directing the bill to the patient’s account seems to be the logical thing to do, nobody seems to know why it is not being done. All what is known is that this is the procedure to follow. As it is usually the case with any government operated system anywhere in the world, there seem to be some accounting and administrative issues that have not been resolved. Trying to find out the reasons would be a very costly and time consuming task. I will get back to you if I ever run into a valid answer.

    Blood Bank and Health officials in Panama agree on one issue. The system is in crisis mode and requires an urgent overhaul. The sudden increase of the general and retired population in Panama has pushed the blood supply down to very critical levels. All the studies and recommendations have already been made, the tricky part is to allocate the necessary funds. In the mean time we will have to do with what we got.

  20. They could start with allowing healthy people who are over the age limit to donate. I knew donors over 80 in he US. As our population ages, this is becoming a bigger problem.

  21. Technically there is no reason why very healthy donors over 65 cannot donate blood. However, Panamanians health officials has determined that safest age range donor in this country is 18 to 65. This age restrictions have been establish to protect the patient as well as the donor.

    Blood volume is determined by body weight. Individuals with low blood volumes may not tolerate the removal of the require amount of blood. As people age, the volume of blood and the ability for the body to replace it quickly diminishes. There is also a series of health conditions associated with the aging process that affect eligibility.

    A list of the requirements for blood donations in Panama can be found the Panamanian Ministry of Health’s website. Also the American Red Cross’s website has a great deal of information about blood donation. With a few variations, the requirements in both countries are very similar.

  22. In fact, each hospital makes its own rules. Two hospitals in David have age limits below 65, and other requirements vary as well. They will all tell you that their age limit is “the Law”.

  23. And in fact these hospitals are circumventing the regulations and placing their patients and their donors at risk. Hospitals do not make “the Law”. What these hospitals are doing is taking advantage of loopholes in a law that lacks provisions for enforcement and prosecution. What their motivation may be to do that is beyond my knowledge. The fact that each hospital is stating that their “in house” requirements and age limitations are “the Law” indicates to me that they are not following the protocols as close as the blood banks do.

    This will be my last reply with regard to this subject. Thank you Don Ray for so kindly allowing me to use your blog to ad some clarity to this matter. I hope all of this information has been of any help.

    Live well and enjoy your life in this country! We Panamanians do not have much to offer sometimes, but we are trying really hard to make our country a better place to live for everybody with the little we have.

  24. Since this exchange has already been closed, there is one more piece of information that has been brought to my attention, that with Don Ray’s permission of course, I would like to add.

    The main reason why the trading on blood has been declared illegal in Panama is to prevent the commercialization in large scale of blood of unknown sources. The existing loopholes were left in place to allow for the sale or purchase of blood by individuals in cases where a particular blood type is not available or a life is at stake. Hospitals, due to the sole nature of their activities, must follow regulations. But again, since no legal consequences are attached to these practices, some hospital tend not to follow the protocols. Blood that has been collected and processed by a blood bank is the safest alternative.

    Again, thank you Don Ray!

  25. David,

    Comments are still active. If I want to close a discussion, then I close comments and it is impossible to add more comments. I think this has been and a good exchange of information.

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