Honora Wempren – La Mesa, CA
As told by his daughter, Patricia Berry:
Even though I have been in nursing nearly 25 years and have worked directly with cardiologists for the last 12 years, I was unable to protect my father from his HMO and get him the care he needed.
Most people of my father’s generation continue to hold physicians in high regard, and believe that they will be honest enough to provide them with the best medical care and advice that is currently available. Most are unaware of the fact that some physicians are willing to compromise medical care in order contain costs for the HMO and secure for themselves a financial bonus in the process.
My father was thrilled to have a pension benefit of health care coverage for his retirement years. Unfortunately, he did not understand that HMOs and traditional health care are not the same.
My father had a medical condition known as Aortic Stenosis. In an elderly individual, the aortic valve may calcify and narrow. As the valve continues to narrow, it becomes increasingly more difficult for the heart to pump blood out to the rest of the body. Eventually the heart begins to fail, and irreversible heart damage can occur if surgery is not performed in a timely manner. Long term survival and quality of life are significantly reduced when surgery is delayed – as it was in my father’s case.
My father had a heart murmur indicative of aortic stenosis for at least 12-15 years. There is a strong family history of stroke and heart attack and my father suffered a heart attack when he was in his fifties. He had long standing high blood pressure, and had a pacemaker. Despite this significant history of heart disease, his HMO chose not to follow him with a heart specialist.
In February of 1995, it was noted on a routine referral for a pacemaker check, that his heart rhythm had changed. This is the first clue that his heart was beginning to show signs of strain from the narrowed valve. Physicians who have since reviewed his medical records say that his aortic valve was severely narrowed at this point and further testing should have occurred.
I tried several times to contact his HMO physician to discuss his case, but he did not return my phone calls for over a month. When he did finally call, his message on the answering machine was so intimidating that I was concerned that if I called back my father would not be treated appropriately.
In November of 1995, my father complained to his physician that he was short of breath, felt rotten, and couldn’t walk anymore. The physician decided to schedule my father for a procedure to correct the irregular heart beat that was discovered back in February. One would have thought that it would have been scheduled right away, but no, the surgery was scheduled for January of 1996!
Unfortunately, my father’s health continued to deteriorate. He could barely walk or pick-up objects, even talking was an effort. I took him to the emergency room, hoping he would receive the urgent care he needed. But after waiting 4 hours in the emergency room, we were sent home–with no treatment. The next day surgery was discussed, but still our HMO was insisting it be done in January. We prayed that my father would make it through the holidays.
On January 2, 1996, my father underwent a procedure to correct his irregular heartbeat. His health did not improve. Days later he was back in the emergency room, his lungs and liver were congested with fluid and his legs were swollen to twice their normal size.
I found out that my HMO had a patient care advocate and I contacted them and told them the entire situation. They were unable to tell me where I could go for help or who I should complain to. To be sure, they were useless. I have nothing but criticism for that department.
My father was finally admitted to the hospital, and 10 days later underwent open heart surgery. But, it was too late, his health never improved. According to a physician who reviewed my fathers chart, the battle was lost between February and December of 1995. His surgery had been delayed until irreparable heart damage had been done. He never fully recovered from his surgery because of complications that set in and he soon passed away.
Because my father received his health care through his employer, his HMO is protected by the ERISA loophole. This loophole shields HMOs from legal liability when they delay medically appropriate treatment. Until HMOs are held accountable for the medical decisions that they make, they will continue to deny and delay expensive treatments that cut into their profits and their bottom line. They have nothing to lose, because ERISA is their goose that lays the golden egg.