Why not take her to an urgent care clinic. Not as cheap as $20, but way cheaper than an emergency room. They are open from like 6 to midnight. No ethical issues.

I wonder what's the true cost to the hospital of 'missing supplies'? Do they not do stock-takes and audits of supplies? If so, these would come up as missing? Which might launch an investigation, or involve accounting, all incurring costs? An investigation might cause the wrong people to be suspected and blamed? What happens if they think they have IV bags left according to their stock takes, suddenly need one for an emergency, but find none? If it should be OK for one doctor to do this, then why not three doctors? Or five doctors? When does it become a problem? What is the cost of all the stock-taking infrastructure and man-hours to prevent such problems? A lot more than $50.

Admittedly, what I know about running a hospital I learned from House MD. I do run a small business, and realize that the costs of things like petty theft can run much higher than the brute cost of the good itself. E.g. if someone has stolen the printer paper or causes the paper to run out printing personal stuff (as happens), I might find myself unable to send, say, an urgent contract out, and if this is say just before Xmas break, the delays that can result could cause us to only get some major income, significantly later, as financial departments close down etc. (in fact, this ALMOST happened to me just a month ago).

"Even more disturbing, Marantz is a bigwig at a medical college and he doesn't get that it's nobody's $50 to pay but the guy's or his auntie's"

Heh, that's nothing, the guys running the entire country and fiscal and monetary systems also have absolutely no clue how to work with money.

While I agree with Amy's advice in theory, I have to wonder what sort of administrative hurdles the doctor might encounter in asking for permission and reimbursing the hospital for the supplies. If there are a stack of forms and a number of people he has to go through while his grandmother is lying there dehydrated and needing emergency treatment, I'd tell him to just take the stuff.

When dealing with big institutions, it's often much harder to ask for permission than it is to ask for forgiveness.

My viewpoint -- if you can walk into a typical pharmacy and buy the same stuff -- then you are totally in the wrong.

If you can only get it from a hospital or medical supply house, then you should pay it back.

And especially as a doctor -- yes you saved the ER/Urgent Care money. But would it hurt to find a way way to pay them back for the supplies you took.

I'm against having to go to a doctor for basic prescriptions (i.e. vaccines, insulin, cold meds) but I'm also against theft.

No, hospitals don't keep track of much, other than scheduled drugs. My hubby does the yearly inspections on most every piece of equipment in a hospital. It's amazing the number of things that simply can't be found.

I'm pretty much in agreement with Jim P, but consider for a second the considerable overhead of the ER. The rest of the patients, and possibly taxpayers shoulder that. Someone who should have paid her share did not. It's not just the supplies.

Look at auto repair places, the part is only $50, the mechanic doesn't get $75 an hour, I'm being robbed when I get billed $300. Except I don't know what I need, or where to find it, or have the tools and training to fix it, or have to pay taxes on the business...

I think things like these unique Apple screws so people can't change their own batteries are a total rip-off. If you can do something, and what you do won't harm others, go ahead. (You are an adult. If you want to snow blow your roof, don't look to me for sympathy when you fall off and break your neck.)

I am glad the ER is there. May I never need it.

I wonder what would have happened had something gone wrong with the elderly aunt? Loss of license? I usually save myself trouble when I ask "what could go wrong?"

"Look at auto repair places, the part is only $50, the mechanic doesn't get $75 an hour, I'm being robbed when I get billed $300"

Off-topic, but I find it curious that at the same time you have such high prices for things like car repair, plumbers and even e.g. domestic cleaning services, you also have high unemployment in the US. What should naturally happen is that the unemployed would migrate to offering such services at lower cost, simultaneously increasing employment and lowering cost of services (since it's better to be working for slightly less than you'd ideally want, than not working). This happens in many other countries. I use a back-yard mechanic who works quite cheap. I used to use low-cost domestic labor before they created minimum wage laws here making it not worth it.

Not being from the US, what prevents this from happening, i.e. the unemployed entering high-labor-cost markets to profit, and create competition? Minimum wage laws? Over-regulation? 'Occupational licensing' requirements? All of the above?

I really don't have a problem with the doctor going to his aunt's to treat her. Much better that she gets prompt attention at her home than spend six hours waiting at the so-called "emergency room". (Yeah, I'm cynical. Can you tell?)

Yes, he should reimburse the hospital -- in theory. In practice, the hospital likely is not set up to disburse those items or accept payment in that manner. So you'd have a parade of hospital administrators wading through various policy manuals trying to identify the proper forms, and eventually they'd give up and throw it over the wall to legal, who will get around to issuing an opinion in two weeks or so. And if it's even possible, the hospital will mark everything up so that that $50 bag of saline and miscellany winds up being billed at $600.

The elephant in the room here is the fetishing of the hospital. Why should it be necessary to go to a hospital just to get a freakin' bag of saline? Why shouldn't one be able to get saline and the associated plumbing at a pharmacy? It's just salt water, fer chrissakes. It doesn't require millions of dollars of equipment to administer. Clue: medical labs stick patients all the time in order to draw blood, and they don't have any special setup for medical emergencies. In the unlikely event that they have an emergency, they do what everyone else does -- call an ambulance. My wife's been in the medical lab business for over 30 years and she's never had a patient emergency.

Hey - you can buy this stuff on-line. Go look.

"The elephant in the room here is the fetishing of the hospital. Why should it be necessary to go to a hospital just to get a freakin' bag of saline? Why shouldn't one be able to get saline and the associated plumbing at a pharmacy? It's just salt water, fer chrissakes."

Good question.

What should naturally happen is that the unemployed would migrate to offering such services at lower cost, simultaneously increasing employment and lowering cost of services (since it's better to be working for slightly less than you'd ideally want, than not working).

My sister would probably agree with you here, but this thinking made me crazy.

I would hire someone through an agency to care for my father, and she would negotiate a separate agreement with them. The agency's rates were higher -- and nonnegotiable -- but I knew they were taking care of taxes and disability insurance, and we had some legal recourse if my father were mistreated. My sister would negotiate a lower fee, which sounds great, except these aides insisted on being paid in cash, and I'm certain they were not reporting the money to the IRS.

Sometimes doing things through a central authority makes things easier in the long run.

Off-topic, but I find it curious that at the same time you have such high prices for things like car repair, plumbers and even e.g. domestic cleaning services, you also have high unemployment in the US. What should naturally happen is that the unemployed would migrate to offering such services at lower cost, simultaneously increasing employment and lowering cost of services (since it's better to be working for slightly less than you'd ideally want, than not working).

The problem with that is that, except for the possible exception of domestic services, you can't just jump into those type of service jobs, because there are typically barriers to entry in the form of regulations regarding certification and licensing. Many States require YEARS of apprenticeship to become independently licensed, and if the companies where you can get that experience are not hiring, you're out of luck.

That the LW sought a columnist's advice tells me he feels he owes a debt which he probably can't settle easily due to the bureaucracy other posters mentioned. Perhaps he feels he needs an external perspective to avoid the slippery slope of entitlement - hey! I can take whatever I want from the hospital! - next time auntie gets dehydrated. But he should also recognize that he showed initiative and resourcefulness in his response.

I don't think the problem with people switching into trades like auto-repair and plumbing comes from regulation. It comes from a lack of skills.

Firstly fixing newer cars is more difficult than fixing cars of old. Almost anyone with a car has been screwed by a shade tree mechanic in over his head, or has heard stories. One of my friends just had a "mechanic" who was changing his brake pads set of the airbag in his car.

The second and probably more important lack is a lack of marketing skills. I always ask people who are starting new businesses where their customers will come from. Few ever know.

Not being from the US, what prevents this from happening, i.e. the unemployed entering high-labor-cost markets to profit, and create competition? Minimum wage laws? Over-regulation? 'Occupational licensing' requirements? All of the above?

It depends on the profession and the state. Domestic help can be hired cheaper one-on-one - meaning I could go out and hire an individual - if I hire a company it is a lot more because of insurance, etc. Most people don't want to hire individual because there is little recourse if say the individual steals from them. The only way is conviction in court and restitution.

Plumbers are highly unionized so it is hard to get started. You have to get a license and a bond. The license is a no big deal if you can get the apprentice experience.

Simple car repair has come down in my area mainly in the form of sales. Things like 25% of oil changes. Most the shops require some certifications to hire someone. Starting a shop is quite expensive - you have to have a lift or a pit, you have to proper control of the chemicals so they don't get into the ground, not to mention all the tools. I recently saw on the news that somebody was opening a rent-a-garage for working on vehicles and it comes fully stocked with tools, etc.

Unless this doctor is still paying off his med school loans, what is he doing even asking the question? Because it's "administratively inconvenient?"

P.S. I much prefer Our Ms. Goddess to Randy Whitzhisdeal. I find The "Ethicist's" questions obvious, and his answers obnoxiously self-
referencing - AND ANNOYINGLY UNFUNNY where he thinks he is being riotous.

The doctor should make an anonymous donation to the hospital. If he or she goes to an administrator, it will cause a problem for the administrator and the doctor. Take my word for it. My wife is a medical administrator and a doctor.

This dude sounded like he might be named Gregory House, M.D., but I don't think House would've asked a bunch of people about ethics afterward. He would have simply gotten into an argument with the luscious Dr. Cuddy.