Bill Schriever – Cypress, CA
As told by his mother, Mary:
My husband and I took my son to the HMO doctor on three separate occasions, requesting a referral for psychiatric care. Under the terms of my coverage with my HMO, mental health care is covered for 20 visits for "crisis intervention."
To this day, I am unable to determine what my HMO deems to be a crisis. Meanwhile, my son was failing school, had performed self-mutilation on his arms by burning and carving himself, used drugs and alcohol, and had several encounters with the police which were becoming more serious. This certainly felt like a crisis situation to me.
We asked for a referral for eighteen months. The first two times we were brushed off by the doctor with the explanation that he was acting like a normal teenager. Realizing the need for treatment, we took him to a counseling center on our own. Bill’s treatment was based on a sliding scale, and we soon realized that he was not getting the kind of professional experienced care necessary. Instead, his counselor was a displaced aerospace worker who was changing careers and performing his internship at this center. We really needed an experienced psychiatrist with a history of successfully treating adolescents.
I called the HMO doctor and again asked for a mental health referral. The doctor told me that my HMO would only approve a referral in the event of a suicide attempt. (Assuming at least some suicides attempts are successful, this probably does tend to save my HMO money.) He stated that he had as a patient a teenage girl who was raped and requested a mental health referral and the HMO would not approve care for her, so they would not approve care for my son.
The doctor prescribed Luvox for him. I do not know much about psychiatric medications, however, I was concerned that the cost was a factor in prescribing this particular medication instead of the more common Prozac. I understand that patients using Prozac may feel relief sooner and therefore may be more inclined to continue treatment. My son decided to quit taking Luvox after twenty days because he did not feel any affect from it.
We were left on our own with no where to turn and my son’s condition deteriorated rapidly. In one of his final incidents, he became very agitated and he called the police. My son told me he was going to have them come over and shoot him. He made a lot of statements about having the police kill him. When the police finally took control of the situation and took him into custody, they were very adamant about Bill needing mental help. Bill and I agreed, but told them I had been unsuccessful in getting him any through my HMO.
While in custody, Bill was seen by a court ordered psychiatrist. She said my son should be considered a suicide risk and should be treated for depression. She said he needed to be in an environment where he could get intensive counseling and was in need of more counseling than he could get in a community environment.
Against our concerns, Bill was sent to the California Youth Authority. I was assured they had good security and that he would be segregated from the more dangerous offenders. Ten days later he was in a fight and died of a brain hemorrhage. I saw him the day before he died for two hours and he looked good. He was joking and asking about the dog, etc. I left thinking that things were going to turn out okay after all. His autopsy notes that he was on Prozac. They never discussed this with me so I don’t know for how long, but I wonder if this is the reason he seemed to be doing better.
I personally don’t think my son would have ended up dead if he could have had the proper medication and counseling much sooner in the process. Because my son received his health care through my employer, we cannot hold our HMO accountable for denying our son the mental health care he so badly needed. Our HMO is protected from legal liability through the ERISA loophole. ERISA shields HMOs that deny or delay medically appropriate treatment for individuals who receive their health care through their employer. Until HMOs are held accountable for their actions they have no incentives to authorize expensive treatment even if it may be medically necessary.