Bess Young – Carmichael, CA
As told by her daughter-in-law, Nancy:
Our entire family in Sacramento has had coverage through our HMO for many years. I believe that the care of my 80 year old mother-in-law, Bess, has lacked consistency and compassion.
One day Bess was found at about 12:30 p.m. face down in her apartment, having suffered a stroke. Apparently, she had been there since the night before. She was transported to the hospital and we met her there. We arrived at the hospital at about 1:15 p.m. The care in the emergency room was good….except for the fact that her broken ankle was not discovered until 7:00 p.m. that evening.
I never heard afterwards from the podiatrist or orthopedist about Bess’ broken ankle. I had to leave several messages to finally get an appointment in orthopedics and then was informed we needed to transport her ourselves to her appointment. This was the most absurd request we had ever heard. Bess had a stroke, she is paralyzed on her left side. She cannot sit up for more than a few minutes without falling to the left, and has been determined to require 24 hour care.
While arguing with my HMO about transportation, I imagined driving down the road with her in the passenger seat. She falls into my lap (her left side) and hits her head on the steering wheel, I lose control of the car. Now we are both dead, or worse, in an HMO! How about putting her in the back seat where she does not fit?.. Maybe the trunk of the car would be a better place…We could just tie her to the roof of the car (we do have a roof rack).
Did our HMO ever consider that neither of us could possibly get her in or out of the car? Or were they just concerned with the few dollars they would save on their end? Getting her out of the car is a task for two, very large persons. The convalescent hospital staff would get her in the car at their end, but what about at the other end? When we tried to find out how to get her out of the car at our HMO, we were told to 1) go to the emergency room…they will help you; or 2) go to the orthopedics parking lot and someone from orthopedics will help you. When we called orthopedics to get their advice, we were told they never heard of the emergency room helping and they don’t help people out of cars because they could get hurt.
It was my continued determination– making phone calls, writing letters, taking time I didn’t have–that resulted in my HMO finally covering transportation expenses for Bess. But I am at my wits end…I have to keep fighting for my family’s health care.
In another instance, Bess received treatment without family approval despite a letter to my HMO that stated, "at the very least, we must be consulted before any invasive procedure is performed on Bess."
The letter continued:
When Bess seems to strangers to be lucid, she may not be. Bess can seem lucid, but if you knew her, she is could be talking about things that never were or people she never knew. She is incapable of understanding any medical procedures…she wouldn’t know what you did or that she even had a problem. The family knows her history. She can’t remember what happened an hour ago. If the family isn’t in on the exam and the decision process, we would have no knowledge for future incidents. There must be better communication.
Doctors had determined that because of Bess’ mental condition, putting her totally under was detriment of her mental facilities and it should be avoided unless absolutely necessary.
So when Bess’ hip went out, we were shocked to learn that they put her totally under anesthesia and popped her hip back in place without any consent from us.
Because Bess received her health care through her employer, I understand that her HMO can hide behind a federal law called ERISA and pay no damages for making decisions that maim or kill patients. This law must be changed so that those making medical decisions are held responsible for those decisions.
There must be better regulation of the HMO industry. Denying medically appropriate treatment to the people HMOs are supposed to be helping is criminal. HMO administrators who have no medical background should not be overriding doctor’s decisions, and if they do, then the HMO should be held liable for the decisions they make.