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Snake bites man, hospital loses financial arm

As the weather turns warm, people and rattlesnakes are more likely to collide on Valley hiking trails or during backyard landscaping. These unwanted interactions often have a costly end, such as the $100,000 bite that will be hitting Sonoma Valley Hospital's bottom line after treating a snakebite victim.

"Snakes don't discriminate - they don't know who has insurance. In this case, the person didn't have insurance," said Rob Feldman, chief financial officer at Sonoma Valley Hospital, who added the total cost of treating the patient could run the hospital up to $100,000. "We're basically going to foot the whole bill. It is a huge expense, but it speaks squarely to our community obligation."

The patient was rushed to the hospital after being bitten by a rattlesnake while working outside last week. After arriving at the hospital, doctors immediately began treating the infection with the antivenin CroFab, a product the hospital keeps on hand.

"It's very expensive," said Chief Medical Officer and ER physician Dr. Robbie Cohen. "I think our cost is about $1,500 a vial. You can use between 12 and 30 (vials) on one bite."

Maintaining enough supply of CroFab on hand to treat any bites that may come into the emergency room is a worthwhile expense the hospital said. While some smaller hospitals rely on getting antivenin from larger hospitals in the event of a bite, Sonoma Valley Hospital keeps a steady supply on hand to treat the average of two to four bites it sees each year.

"We stock it here, and it's extraordinarily expensive," Feldman said, comparing the antivenin to TPA, the costly drug given to heart attack patients. "It costs a lot to be ready for that heart attack victim. It takes a lot to be ready for that snakebite. But that's part of being a community hospital, being ready for whatever walks in the door." 

Cohen said in his decades as an emergency room doctor, he has treated numerous snakebites but has never seen a death from a rattlesnake bite. This is at least in part due to the fact that the hospital can quickly treat a patient with CroFab instead of waiting for antivenin to arrive from another facility.

While insurance often covers the medical costs associated with a snakebite, those without insurance are left holding the bill. When there's no way a patient can foot $100,000 in medical care, the debt falls to the hospital. Feldman said this type of coverage for uninsured patients is where much of the annual parcel tax is spent.

"This is a kind of example where a lot of (the parcel tax) goes," he said. "Those kinds of things get supported when you support the hospital."

This time of year is especially dangerous for rattlesnake bites because the juvenile snakes begin to appear. While an adult rattlesnake can control the flow of the venom it releases, a juvenile will release all the venom it has, which ultimately requires a larger dose of antivenin to treat. Cohen said that with common sense, bites can be avoided.

"I would say 75 percent (of bites) are because someone did something they shouldn't," he said, adding that he's heard stories of people picking up the poisonous snakes with a stick or not exercising caution when moving through the higher brush where rattlers live. "(Rattlesnakes) usually stay away from people, it takes some effort to get bit," he said. 

Bites to humans and other large animals typically occur when a snake is startled and reacts out of fear. Rattlesnakes recognize that they cannot eat people and won't seek to harm them. Snakes use venom to subdue their prey, and thus when a snake releases venom into a human it is unable to eat until it replenishes that supply of venom.

"They don't want to bite you, venom is precious to them," Cohen said.

He added that there are many myths about how to treat a snake bite, including sucking the venom out of a bite or using a tourniquet to stem the flow of venom into the bloodstream. He said these are not worthwhile efforts, as the main focus should be getting the bite victim to a doctor as quickly as possible.

"Do nothing in the field and get to the hospital promptly," Cohen said.