Examination of financial charges associated with intentional foreign body ingestions by prisoners: A pattern of escalation

INTRODUCTION: Intentional ingestions of foreign objects (IIFO) continue to be prevalent among prisoners. Our previous research examined determinants of hospital admission, endoscopy, and surgery among prisoners who ingest foreign objects. However, little is known about the financial impact of these events on healthcare facilities that service the prisoner population. This study aims to fill this gap by examining hospital charges attributable to 435 prisoner episodes of IIFO. METHODS: A retrospective review of all prisoners who presented to our medical center with the complaint of IIFO was conducted. Both IRB and Bureau of Prisons approvals were obtained prior to data collection. All prisoners ages 18-75 were included between the dates of Jan 2004 and Dec 2011. Episodes were divided into three categories: (a) unverified IIFO wherein ingested object was claimed by the patient but never identified; (b) verified IIFO wherein ingested object was clearly identified; (c) secondary events due to direct complications of previous IIFO episode(s). The temporal occurrence of IIFO was organized by increasing number of episodes and grouped accordingly. Detailed list of hospital charges was obtained for every IIFO episode, including: (a) emergency services; (b) procedures; (c) laboratory; (d) surgical supplies; (e) allied health services; (f) radiology studies; (g) anesthesiology charges; (h) pharmacy; and (h) intensive care costs. Descriptive statistics were used to analyze basic data. Kruskal-Wallis test was used to examine differences among nonnormally distributed variables and sub-groups. Statistical significance set at alpha = 0.05. RESULTS: A total of 435 IIFO episodes occurred during the study period in a population of 125 patients (mean age 33.8±11.7 years, median age 34 [range 19-75] years, 92.8% male). Hospital charges associated with these episodes totaled $6,209,557. There were 94 unverified IIFOs, 332 verified IIFOs, and 9 secondary events. Verified IIFOs were associated with significantly greater median charges ($5,860) than unverified IIFOs ($3,997) and secondary events carried lower cost ($3,501) than the former two (p <0.01). We also observed a pattern of escalating costs associated with increasing number of sequential IIFO episodes, with the 1 episode carrying median charges of $4,683 and episodes numbered 11+ carrying median charges of $7,698 (p <0.01). CONCLUSIONS: Hospital charges associated with care of prisoners who ingest foreign objects tend to escalate over time. Although charges in most of the categories demonstrated increases with greater numbers of ingestions, the largest contributors to this pattern of escalating charges included radiology, pharmacy, hospital room charges, and surgical services. These findings suggest that early intervention in the destructive cycle of IIFO may not only improve patient outcomes, but also result in savings to the healthcare system. Cite as: Otey AJ, Houser JS, Jones C, Evans DC, Dalal P, Whitmill ML, Levine E, McKimmie R, Papadimos TJ, Steinberg SM, Bergese SD, Stawicki SP. Examination of financial charges associated with intentional foreign body ingestion by prisoners: A pattern of escalation. OPUS 12 Scientist 2014;8(1):6-8. Correspondence to: S. P. Stawicki, MD FACS. Department of Research & Innovation, St Luke's University Health Network, 801 Ostrum Street, Bethlehem, Pennsylvania, 18015 USA.