Death by HMO

Yesterday at a small community hospital in South San Diego, a 49 year old woman was left to die by her HMO.


She was admitted to a medical floor and then transferred to ICU after doctors discovered that she had a bleed in her brain. Things started to go wrong immediately. It was apparent that the woman needed a neurosurgeon and more specialized equipment than this small hospital could provide. She needed to go to a bigger hospital immediately if she was to recover.


Starting at about 11:00 am doctors at the hospital began calling their colleagues at other San Diego hospitals to find a bed and treatment for her. Physicians at the other hospitals were ready and willing to take her immediately. Everyone at the hospital from the CEO to the ER doctors worked all day with her HMO and other hospitals to get this woman to a large fully equipped facility so the bleed in her brain could be stopped. Hospitals would be found, only to have the administrators ultimately refuse claiming they didn't have a bed.  Scripps Hospital, a prestigious institution, kept them hanging for FOUR hours while the bleed in the woman's brain spread, killing her slowly. Meanwhile fifteen members of her family looked on and waited, seemingly unaware of the severity of this woman's illness and unable to negotiate the health insurance maze to advocate for her.


Finally at about 6:00 pm, after hours of frenzied calls by the staff at the community hospital, a transfer was approved. By this time she was in critical condition and every minute counted. She was loaded into an ambulance and transported. She faced a long drive since the new hospital was miles away. But by this time, the woman who had been alert and talking at 11:00 am was near death, unconscious and unresponsive. 


What happened to this 49 year old woman could happen to anyone with a for-profit medical insurer.  Her HMO waited for 7 critical hours to approve transfer and treatment at an appropriate hospital. Doctors at other hospitals were willing to treat her, administrators, focused on the bottom line, were not. Ironically, if she had no insurance, she would have been better off. If she had come into the ER instead of landing on the medical floor she would have been transferred immediately to another facility upon diagnosis.  In either of these cases, those other hospitals would have been required to treat her with or without her HMO's approval.


A  serious crime was committed here. More than one person, not a computer, not a faceless institution but actual HMO personnel and hospital administrators, denied this woman the treatment for which she paid and was entitled. But far worse, those persons knowingly participated in the death of a woman for profit. Given the information supplied throughout the day by hospital doctors, both the HMO and the hospital administrators knew how critical the woman's condition had become. And still, they delayed letting her languish untreated until it was too late.  Someone, anyone, should tell the family that they need a lawyer to sue the HMO for conspiracy to commit murder and murder with special circumstances because that is surely what they did. Her death wasn't caused by negligence but by a delay intended to avoid paying for services. Murder for profit. That's our health care system.