Tuesday, July 17, 2012

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. 

Sunday, July 8, 2012

Summer in the City

New York City never takes a break, sleeps, or slows down. Last week NewYork sweltered in 90+ degree heat partnered with typical summer humidity. That number doesn't begin to tell the story of the Big Apple in the summertime. I spent the 4th of July in NYC having arranged to meet a friend from Minneapolis there and stay with her at her daughter's apartment.  Her daughter was in Hawaii so we or rather my friend was taking care of the dog.

Her daughter's apartment is in a huge 43 building complex built in the 40's called Stuyvesant Town near the East River. The grounds are gorgeously landscaped with mature trees, huge blooming hydrangeas, fountains, playgrounds, and gardens. Strolling through Stuy Town you can imagine yourself at quite a distance from NYC. Walking the dog through the gardens the traffic seems barely audible.  The paths are shaded and clean, a cooling breeze ruffling the trees. Stand next to the huge fountain and enjoy the refreshing mist or play in huge water fountains designed for just that purpose.

Leave the grounds and New York City gets right in your face. At 90+ degrees it's like stepping into a 350 degree oven and closing the door. The heat from the asphalt shimmies up your skirt while the sun bakes your face.  I don't know where "they" get the air temp to report but it isn't from a thermometer at street level. The sidewalks, buildings, and cars gather the heat and reflect it back at pedestrians. Along with heat comes the humidity which only increases your discomfort.  I can imagine that before Manhattan was filled with skyscrapers breezes brought the residents a modicum of comfort but now the buildings block air flow superheating the city.

The heat causes more than sweat. On an outing one night to Big Gay Ice Cream our route took us down a particularly unsavory street.  Trash bags piled on the curb gave off all manner of revolting odors.  The smell wafting back to us of the man walking 10 feet ahead  was reminiscent of men's locker rooms after a tough game.  Truly the most disgusting, stomach turning smell was the sewer gas drifting up from god knows where.  I doubted whether I could eat ice cream, gay or not, after walking several long blocks enveloped by such a repulsive miasma. Fortunately, we turned off 1st Street down a darker, tree lined street where the air was significantly improved. We did manage to eat ice cream, soft serve with key lime curd, graham cracker crumbs and whipped cream! Mmmm...delish!

Let's face it, in addition to the nearly unbearable heat, the City is also noisy and dirty.  Cars honk, ambulances whine, and the sidewalks are spotted with permanent dirt.  After walking around the City all day and riding the subway you are smelly, crusty with salt and dirt, and exhausted from the assault on your senses. You crave a cool quiet escape from the summer in the City and a chilled glass of Chardonnay. Which is just what we had.

Well, maybe more than one glass, it was really hot after all.