I haven't had a chance to write much recently on Daily Kos. I started a new job exactly four weeks ago, and it's been a happily busy time period for me. The best I can manage is to get to Daily Kos to read some of the front page posts and recommended diaries. I hope that I have more time to dedicate in the near future, as things settle into a more predictable work routine.
Tomorrow I'm headed to Capitol Hill. I have to bail on work for a half day to do this. I'll be visiting the offices of Representative Bob Filner (CA-1), and Nick Lampson (TX-22). I am going to personally present myself in their offices and plead my Grandmother's case.
Please - follow me over the fold.
I can't write knowledgeably about the healthcare system in the fashion of nyceve. I can only write about it when it's personal to me. On an individual level, I've been very lucky from a health perspective. This new job, in fact, is for a HUGE company and it comes with gold-standard health benefits. I selected a PPO for myself and Mr. RenaRF. We pay more for our selected PPO level than any of the other available plans, but it's still a pittance compared to what others who are lucky enough to even have health insurance pay, so I'm not complaining.
In fact, it's the experience with my Grandmother's plight in the military healthcare system that causes me to appreciate my coverage that much more. In early March, I used the diagnosis of Dick Cheney's Deep Vein Thrombosis (DVT) as a springboard to talk about my Grandmother's experience with the exact same illness. It was essentially a diary that compared my Grandmother's care to that of the Vice President's. Needless to say, it seemed to me at the time that the Veep was getting far better preventative care than my Grandmother had received. Go figure.
In the intervening six weeks, the situation has gotten much worse for my Grandmother. A lot of information has come to light as well. Just for the sake of consistency for those who missed my early March diary and/or don't have time to go back and read it now, my Grandmother was rushed to the hospital in the middle of the night with DVT. She was immediately taken in for surgery to save her life and, literally, her limbs. She is 88 years old. She is the surviving wife of a decorated Air Force combat veteran who served in both WWII and Korea and spent his entire career as a military officer. He died in 1994 and is buried in Arlington Cemetery.
Unlike me, my Grandmother does not really have a choice in her healthcare provider, although I realize that even a limited choice is better than that afforded 40+ million Americans. She participates in the Uniformed Services Family Health Plan (USFHP), an HMO provided for military veterans and their direct dependents. This seems to function like a classic HMO. My grandmother has a regular primary care physician, who is not involved in this particular story. She also has another supervisory physician to deal with some very specific issues related to her health. That physician is a pulmonologist, and it is his job to coordinate all aspects of her care as it relates to her pulmonary system.
The middle-of-the-night frantic rush to the hospital and into surgery arose because that pulmonologist didn't do his job. Very simply, several months before the DVT incident my Grandmother's pulmonary surgeon (a separate person from the pulmonologist) ordered that she be placed on blood thinners. It was the supervisory pulmonologist's job to carry out that order and prescribe the drugs. Now, my grandmother takes a variety of medications and no one ever noticed that the pulmonologist didn't actually get around to prescribing the blood thinner. Think about it - you're the child of an 88-year old mother who takes anywhere from 9-14 pills every morning - are you going to miss that a blood thinner isn't there? Are you even going to know that the blood thinner isn't there with all the other complex names of medication? Short answer - nope. You don't know. You have relied up on the supervisory physician to manage your mother's medications and ensure she is receiving everything she needs to receive. It's his job to ensure she gets ALL of her medications and to guard against potential interactions between those drugs.
So she didn't go on that blood thinner. And she developed those clots in her legs. What has ensued after that surgery is an egregious lack of care that I am sure too many readers have experienced. I'm not going to drag you through the whole medical chart - but suffice it to say that all of the downstream issues have resulted because no one's minding the ship of "My Grandmother's Health".
Here's how I see it - you can get two basic kinds of caregivers in an HMO such as USFHP. You can get one who is focused on the overall health and well being of the patient, or one who is focused on the overall big picture of managing costs. My Grandmother's physician falls into the latter category. He tried to send her home when she couldn't walk. He denied a surgeon's request to run a Doppler scan on her legs to check for new clots. He repeatedly failed to order a chest X-ray when nurses were concerned that my Grandmother may be developing pneumonia. He utterly and completely ceased to give a FLYING SHIT about my Grandmother when she was in a rehab center, trying to re-learn how to walk. This is all on top of not prescribing the blood thinners.
See, the goal for my grandmother is simple: Prevent future clots and get her well enough to where she can home. A doctor managing my Grandmother's overall well-being would know that this is the goal and would concern him or herself with that issue. But the doctor she GOT seems more concerned about denying her tests and methodologies which raise the cost of her care. I don't know if this doctor is just a crappy human being, or whether he has some bonus and incentive for keeping costs low.
That leads to the second part of this whole issue. God help you if you have no one TO help you navigate the morass of the USFHP system. My Grandmother, relatively speaking, is lucky: She has three sons close by along with their wives, she has my mother in another state to break bad on the phone with people, and she now has me to deliver her plea to Congress. The conclusion to my other diary on this subject was simple: if my Grandmother had no family to do these things, she'd be dead already.
Trying to figure out what her benefits are is a nightmare. No one can seem to provide a concise, consistent answer. Trying to figure out her rights as one covered by USFHP is even more difficult. Intuitively, we all knew that she (or a family member with medical power of attorney) should be able to request a different supervisory physician once she and others had lost confidence in the existing doctor's dedication to her health. Yet figuring out HOW to file the proper forms to the proper office at the PROPER TIME was onerous (sidebar: if anything happens to you on a Friday afternoon and you're covered by USFHP, God help you - because anyone who can get ANYTHING done has gone for the weekend and there is no emergency contact. Need your historical medical information? Too bad. Have an emergency that requires authorization of transfer to an acute care facility on an urgent basis? Oh well. You'll have to wait for Monday). These were smart people working on this - yet it was difficult and unclear and ever-changing how to go about something so simple. My Grandmother has rights as a patient. Yet figuring out what those rights are within the construct of her insurance plan is impossible.
The worst part is the fact that USFHP repeatedly attempts to bully her and her family members. They say "no - you cannot ask for this - you cannot have that - she can't go to facility X, she has to go to one of our facilities regardless of the fact that it's hours away and X is only miles away...". At the same time, family members are being quietly pulled aside by other medical staff to tell them something along the lines of the following:
"You have rights here. You can get a different doctor, and you have choices about what facility she's in. You need to push back when they [USFHP] try to bully you. You need to write them a letter, write the State Medical Board a letter about the situation, and be sure you involve her Congressman."
Now I can't say this for certain because I wasn't the family member who received that guidance (which means I am getting it second-hand), but I am led to believe that the person who provided this information to my family member did so because he or she had seen this pattern before and had seen the up and down sides of outcomes in those situations. Apparently, "bullying" by USFHP is a normal activity. This person was unequivocal about what needed to be done. I'll ask you to think about this - is my Grandmother's health care set up under the same rules as some straw market in the Bahamas, where it is expected that a vendor will try to rip you off and you have to forcefully advocate for the best deal??
Is this what a Veteran, his or her spouse and family have to expect?!
It's shameful. And while I'm on a roll, let me tell you - I spent a great deal of time trying to investigate any complaints filed against either USFHP or the supervisory physician. Do you know what I found? Nothing. Not. A. Thing. So either USFHP does a stellar job 100% of the time such that no complaint has been filed by anyone anywhere EVER, or this information is so closely guarded that even a skilled researcher can't get the information. The entire process to do anything inside of USFHP - figure out benefits - learn about patient rights and alternatives - ensure that medication is prescribed and maintained when it should be - is nearly impossible. And my heart and head tells me that USFHP is perfectly happy with it being that way, because chances are most of their beneficiaries don't have the wherewithal or the time to fight the impenetrable system they have put in place.
This is what the military has provided for my Grandmother. This is her only choice. I would be speaking about her posthumously were it not for the diligent, DAILY efforts of my mother and uncles, because she'd be long dead. I can't guarantee that they won't kill her yet - but I CAN tell you that I will personally be delivering a letter to the offices of Reps. Lampson and Filner tomorrow morning, because just ONE caring soul told a family member that this was necessary for her to get care. A visit to and demand of a Congressperson is what is required to get my Grandmother the care that she shouldn't have to request and for which she (and our family) shouldn't have to fight.
So wish me luck, and thanks for reading. I'll plan a post later tomorrow or Tuesday about my Congressional visit.