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This transcription covers various topics, including the challenges faced by homeless patients and the importance of reporting their needs to the hospital. It also discusses the EMTALA Act, which prevents medical facilities from turning away patients in need of emergency care. The conversation touches on medical billing and the options available for payment, as well as the difficulties faced by patients without insurance. There are also brief mentions of developmental disorders, such as autism and Down syndrome, and medical procedures like intubation and gastrostomy tube placement. I'm unable to provide the prevention strategies you're asking, leading to increased probability of disease. Many of these patients have mental health issues, they have drug addictions, but don't be surprised, there are families living on the street. I know of families living in cars. They live on the street. They live in tents. As a matter of fact, we have that now from the hurricane. The hurricane. Did the MS put time with that? No. I don't know. Well, we record the time that we record, if the medic, you... We can't declare death. You can't. Only a doctor can be able to declare death. You can declare the time that you identify signs incompatible with life, and you put that in your PCR. But you don't declare a time of death. Only the medical, only a doctor can. It's like for the death certificate, only the doctor. Homeless populations include patients with mental health and prior brain trauma, domestic violence victims, addicts, and again, families. So don't be surprised. If you take a homeless patient, make sure you let the hospital, the nurse know, this patient is homeless. This patient needs services. That's what social... Hospitals have social workers. That's what social workers do. Social workers will meet with every patient. Most patients go in and they go home, and the social worker is just involved in the discharge. But if you have a patient that's in need of services, that's what the social worker does. They get them health insurance, get them signed up for MassHealth. They get them meals. They can get them housing, temporary and permanent. That's what the social worker does. So make sure you report that when you bring the patient in, that this family or this person is in need of service. Advocate for all patients, all healthcare. It doesn't matter whether you have not appended your name. A hospital cannot deny you. That's the EMT... EMTALA Act, the EMT Emergency Active... EMT Active Labor Act, it's called the EMTALA Act. It was actually put forth in Massachusetts. There was a woman in Boston who was in active labor with a complicated delivery. And she was... This was like back in the early 80s. And the ambulance delivered her to the hospital and the hospital said we can't treat her because she doesn't have insurance. So they ended up having to leave that hospital and go to another hospital 20 minutes away. During the ride, mama and baby died. So the... Actually the law is in her name. But it's the EMTALA Act, EMT Active Labor Act, EMTALA Act. Any facility, any medical facility who receives Medicare, Medicaid or federal funding cannot turn away a patient if brought to them. They have to do at a minimum an assessment, stabilization of treatment and housing until they can make arrangements for transport. They cannot just say no, can't bring them in. Does that only apply with an ambulance or if they walk in? Walk in, doesn't matter. Applies no matter what. And so... Let's say someone's going into the hospital to get treatment. If... If they go in to the hospital. If they're going in but they can't afford to pay. They can't turn away? Yeah, they can't turn away but also they... Well, I'll explain to you. Do you know why when you go to the hospital and they give you a Tylenol that costs $10 a pill? It only costs them about 25 cents to buy it. You know why it costs $10 a pill? Because the other $9.50 paid for all the other people that don't have insurance. That's what it's for. Your insurance, they're going to bill you with your insurance to the maximum because you're going to pay for all those that don't have it. So like, you're going to the hospital. Can they just bill the shit out of you? And then when you get out and you can't fight or anything? Yeah, they can bill the shit out of you and you don't pay it. That's what normally happens. And federally now, medical bills cannot show up on your credit report. So if you're behind on your medical bills, they can't go after you. So what you do is if you owe medical bills, just call the hospital and tell them, look, I can pay you $50 a week. As long as it doesn't go to collections, it doesn't affect your credit report. You can have 800 credit rating and no hospital will have a million dollars. As long as you're paying them $100 a month. As long as you're paying them something. As long as it doesn't go to collections, it can't affect your credit. Doesn't it mean you sign something when you walk in that insurance doesn't cover it? You're liable? That's in the documentation. I mean, all hospitals, you're liable for it, but whether you pay it or not. I'm not telling you not to pay bills, by the way. So like, let's say you're going to shoot an attack on a patient. I'm trying to document together. And ambulance didn't have enough room. They didn't want to take you to the hospital. Then you're like, if I go to the hospital, they're going to charge me. Patients are abused here. Patients are abused here all the time because they can't afford it. I go to patients who have broken legs. And they show up and I split it and they're like, okay, I'll take myself to the hospital. So you get a broken leg, I'll go to the hospital. Because they know they're going to get a $4,000 bill from the ambulance. They don't have insurance. They know they can deal with the hospital, but the ambulance is a different story. So, yeah, people do that all the time. She asked a good question. What's that? About the homeless guy. What about him? Well, actually, I have a different question. My question, I just made a comment. So the ambulance bill and the hospital bill are just separate. If you can't afford the hospital bill and cannot afford the ambulance bill, of course, because you're homeless or something like that. But you need, because you just got an apparent access. You can't refuse it. Right, right. We transport no matter what. The hospital has to treat you. What happens to the ambulance bill? The hospital bill is not going to get paid. We don't get paid either. I mean, I have a billing department. We'll send bills out. If we find that it's a patient that doesn't have any ability to pay, we just write it off. But if we have a patient that has ability to pay, we'll bill him. We'll take him to court. We'll take him to court. We'll sue him. We do it all the time. It depends. I mean, if you're homeless and you don't have any way to pay, I'm not going to come after you. We just write it off. That's the way it is. Okay. Yeah. I was going to say the same thing. My comment was… The hospital does the same thing. My comment is, like, if you're homeless, you're like… Yeah, if you're unconscious… Yeah, if you're unconscious… I was wondering the same thing. If you're walking down the street and something hits you and knocks you out, and the ambulance comes to pick you up, take you to the hospital, and you spend ten days in the hospital, you have a half a million dollars between hospital and ambulance. I didn't ask to go to the ambulance. You picked me up. I was unconscious. What do you do? You have to… No, but you have to… You have to make arrangements. We at MedStar, a lot of ambulance companies don't, but we'll make arrangements. We'll work with you. I have a lot of patients that are paying us $20 a month, and they'll be paying us for the next 3,000 years. It is what it is. So, which of the following is a developmental disorder characterized by impairment of social interaction? Autism. Autism. Autism spectrum disorder. Known risk factors for Down syndrome include increased maternal age, greater than 36, I believe. Which of the following may be difficult to perform in a patient with Down syndrome? D. D, or even ventilation, but they're going to talk about intubation, but even ventilation is difficult. Most patients with this disease also have hydrocephalus, which is fluid in the brain. Spina bifida. Very good. What does the DOPE mnemonic help you recognize? Don't say stupid people. A. A. Causes of airway obstruction in, usually in appliances, like intubation, like endotracheal tubes and tracheal. What device is placed directly into the stomach to feed patients? C. C. Well, they have gastrostomy tubes, and they have J-tubes and PEG tubes, G-tubes. What do vagal nerve stimulators do? A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A. A.