Without Healthcare - **** HIM, LET EM DIE.
Social Worker Notes
Uncategorized helenredmond 3:17 am
I got a call from ICU to help identify a patient. He was dying and the doctors needed to get in touch with the family ASAP. I was nervous as I rode the elevator up to the floor. The man was hooked up to every machine invented. Big blue and white tubes going in and out of every orifice, veins impaled with IV’s galore, hyperventilating machines, heart monitors beeping and beating out time, flashing screens full of green lines, zig zagging peaks and troughs, the surveillance of all bodily functions. And I looked at his swollen and sweaty face and saw death.
The nurse told me to enter the room I’d have to gown up, wash my hands, and wear gloves. I didn’t like putting on all the gear, it felt creepy and there were killer germs everywhere and I needed to be on guard. Then the residents came over to talk to me. They explained what happened in voices that betrayed fear, awe, disgust, and disbelief. The patient had an abscessed tooth and they surmised that he hadn’t gone to see a dentist until the infection was out of control. The pain must have been excruciating. He saw a dentist and then went to a hospital ER and got a prescription for antibiotics filled. But it was too late. The infection had spread and he contracted necrotizing fasciitis, the dreaded flesh eating bacteria. Actually, that’s a misnomer. The bacteria doesn’t eat flesh, it pumps out mega amounts of toxins and exotoxins that destroy tissue and organs. The doctors were gobsmacked and said this isn’t supposed to happen, this guy shouldn’t be in this room dying, he should have got the antibiotics on board from the get go. They didn’t expect the patient to make it through the night because the bacteria had invaded major organs and one by one they were shutting down. Domino effect. The super, duper antibiotics – vanc, clinda – that were being pumped into him weren’t doing a damn thing. The two of them just shook their heads. For a moment we all stood around the door to the patient’s room in an awkward silence. And I thought: this guy is going to die tonight, alone, if I don’t hurry up and find someone and tell them to get here, STAT!
I had to go through his belongings, find the wallet, or even better, a cell phone with preprogramed numbers. I lifted the bulky plastic bag out of the closet. I gingerly took a pair of pants out of the bag. They were filthy dirty, the kind of dirt that is so embedded in the fabric that it will never wash out. Pants that are worn over and over and over again, over years - poverty pants. I could see the outline of a wallet bulging from the back pocket and slipped it out. It was a beat up old piece of brown leather that had been well sat on. There was no money, not even a penny. No credit cards. I fished out a few business cards. With my gloved hands, I reached back into the bag and and pulled out a shirt, socks, muddy boots, a black leather coat. I saw the bottles of antibiotics. They were full of pills. No cell phone. Drats!
And then I felt sick to my stomach and scared. I stood there and thought, what am I doing? I was violating the patient’s privacy, a nosy parker, touching his personal belongings, rifling through his things without his permission.
I started calling the numbers on my hospital issued cell phone. I left short, cryptic voice mails designed to create fear and panic and thus, quick call backs. A few minutes later the phone rang. The caller didn’t know the patient. Another person rang and said he’d call someone who might be able to help. Phone rang again, the woman said the patient was an acquaintance but she knew his pastor and would have him to call me. Pastor called and said he was on his way. Whew, the patient wouldn’t die alone after all and who better to be with him than his pastor.
I found out the next day the patient “expired.” The health care system killed him. He was a poor man, no medical or dental insurance. And because he had no access to a dentist, and dental care is expensive, and dentists don’t like to, and by law don’t have to see uninsured patients, he died. If he had been able to see a dentist and got the antibiotics right away he would be alive, it’s that simple. He’s not the first and and he won’t be the last to die this way. Deamonte Driver, a 12 year old boy from Baltimore, died because his tooth infection spread to his brain. The Washington Post ran a story with this headline: For Want of a Dentist. I have another headline, it’s more accurate: Death by Denying Dental Care.
I found out too, that the pastor never came. The patient died alone.
From A Former Executive Of Cigna-Part One
An Interview With Wendell Potter, Former Insurance Flack
By Trudy Lieberman
Columbia Journalism Review
June 24, 2008
http://www.cjr.org/campaign_desk/exc..._6.php?age=all
This past year's health discussion has been remarkable
for the narrow range of ideas and opinions that have
floated down to the man on the street. Journalists have
sought out the same organizations and sources for their
stories, offering up what has become the conventional
wisdom for reform. To bring more voices into the
conversation, our Excluded Voices series will
intermittently feature health care experts who aren't
on the media's A-list of sources. This is the sixth
entry in the series, which is archived here. We want to
offer journalists more options for their stories and
encourage a deeper conversation. To that end, we've
asked the experts featured in each post to respond to
questions from Campaign Desk readers.
Historically, insurance companies haven't topped
reporters' story idea lists. Boring, editors say.
Complicated, reporters think. Of course, that's all
good for the insurers-especially health insurers that
would just as soon not have snooping reporters
scrutinizing their practices. As someone who has spent
nearly an entire career covering insurance, I can tell
you the subject is neither boring nor complicated once
you delve into it. More reporters should do so if they
want to explain what the various bills winding their
way through Congress will mean for the public as well
as for insurance companies.
One reporter who has made something of a specialty of
covering insurance is Lisa Girion of the Los Angeles
Times. Last week, Girion covered the testimony
insurance executives gave before the House Subcommittee
on Oversight and Investigations, and offered readers
some insight into industry-think. The executives told
Congress that they would continue to rescind coverage
for people who unintentionally fail to disclose what
insurers consider preexisting conditions when applying
for health insurance. UnitedHealth Group, WellPoint,
and Assurant Inc. have cancelled some 20,000 policies,
leaving policyholders stuck with medical bills.
Sometimes, companies cite even the flimsiest evidence
of deceit in order to justify rescinding their
coverage. And sometimes they've paid bonuses to
staffers who help purge their books of policyholders
likely to file expensive claims.
Campaign Desk sat down with Wendell Potter, a former
head of corporate communications for CIGNA, the
country's fourth-largest insurer, and now a senior
fellow on health care at the Center for Media and
Democracy. Potter, who also spent four years at Humana,
left the industry in 2008 after nearly twenty years of
promoting its messages.
Trudy Lieberman: Why did you leave CIGNA?
Wendell Potter: I didn't want to be part of another
health insurance industry effort to shape reform that
would benefit the industry at the expense of the
public.
TL: Was there anything in particular that turned you
against the industry?
WP: A couple of years ago I was in Tennessee and saw an
ad for a health expedition in the nearby town of Wise,
Virginia. Out of curiosity I went and was overwhelmed
by what I saw. Hundreds of people were standing in line
to get free medical care in animal stalls. Some had
camped out the night before in the rain. It was like
being in a different country. It moved me to tears.
Shortly afterward I was flying in a corporate jet and
realized someone's insurance premiums were paying for
me to fly that way. I knew it wasn't long before I had
to leave the industry. It was like my road to Damascus.
TL: What was so upsetting about the industry that
pushed you over the edge?
WP: I was in a unique position to know how companies
made money-what they had to do to satisfy
shareholders-and how the industry has been able to kill
reform in the past. I had been part of those efforts
and didn't want to be part of them again.
TL: How did you spin the press to the industry's way of
thinking?
WP: Over the years I developed relationships with key
reporters. When you do that, you are in a much better
position to influence the tone and content of stories
reporters write, or at least be sure that your
company's key messages are included. It's similar to
the way special interests woo members of Congress. It's
not just money; it's relationships.
TL: Did you ever deliberately mislead the press?
WP: I would say yes, if you mean not disclosing some
pertinent information at times. PR people are always
making selective disclosures of information. That's
what you do. I did not knowingly provide inaccurate
information.
TL: How do reporters know what's missing?
WP: They don't. That's why it's really important to
know what you're covering.
TL: Can you give an example?
WP: Most large insurers are marketing consumer-directed
plans. They do research and use selective data to
persuade the public that these plans are popular and
work as the companies say they do. There's a lot at
stake for these companies. They are building their
business models around these plans, so they need to
make them succeed. They need to counter research by
others that shows many people don't get the care they
need because of the high deductibles that must be met.
TL: What else made it possible to get the stories you
wanted?
WP: I quickly learned that reporters, because they're
so busy, haven't learned as much as they should. I was
able to take advantage of that. When companies would
announce quarterly earnings, few reporters had any
understanding of the details of the report.
TL: Do companies let reporters come visit for an entire
day to learn the ropes, as they once did?
WP: Many companies won't do it for fear that something
might go wrong. An executive might say something he
shouldn't. A PR person puts him or herself at
considerable risk by bringing a reporter in. Your job
is on the line if stories are not flattering.
TL: Are insurers better able to control their messages
now than, say, twenty years ago?
WP: Yes. For one thing, the media has lost interest in
writing stories similar to the managed care horror
stories they wrote in the 1990s, when insurers and
employers were forcing people into HMOs. There is less
coverage of the consequences to people resulting from
insurance company practices. A lot of critical
reporting is just not being done. Most reporters
willingly accept a prepared statement that company
executives and lawyers have written, and they feel
their obligation is over. The calls we got were few and
far between after the media lost interest in managed
care.
TL: What insurance stories did reporters write most
often?
WP: They wrote brief stories for investors, but
wouldn't go into the details of the important facts and
numbers-such as a company's medical loss ratio, which
tells the percentage of premium dollars that the
insurers pay out in claims. This is a closely watched
measure by investors and Wall Street analysts, because
it tells them how well a for-profit company is meeting
investors' earnings expectations.
"What a Horrible System", She Said??? Part One
Monday, August 17, 2009
New CMA president Anne Doig urges medicare repairs
SASKTOON -- Anne Doig, a Saskatoon family physician and longtime medical leader, was elected to the position of Canadian Medical Association president last summer in Montreal, but she will officially take over for Dr Robert Ouellet this week, here in Saskatoon. Dr Doig's got a pedigree when it comes to medical politics: her father was among the physicians who opposed NDP premier Tommy Douglas's creation of medicare in 1962, and her brother Chip will be the 2009-10 president of the Alberta Medical Association.
Even more impressive than the depth of her experience in medicine and health policy is the fact that Dr Doig has accomplished what she has in those areas while also making time to have six children, own a grain farm, swim competitively and stay involved with swimming tournaments.
Before the beginning of this year's CMA annual meeting, she spoke to Canadian Medicine about health-insurance reform, the Canada Health Act, abortion (sort of), swimming, and more.
SAM SOLOMON: What do you hope to achieve as president?
ANNE DOIG: I think I’ve already laid out some of that in the material that is circulating. Essentially what this boils down to is taking the information that Dr Ouellet has gathered, learning from GC [CMA General Council] what the membership thinks about that information and the current situation, going out to the membership to ask what we should do -- and, parenthetically, some of that work is already being done through an online forum with Asklepios -- because we need to know what members think needs to be done. I think we need to improve effectiveness and efficiency. What do we think can be done to improve the system? That helps us when we’re asking government to look at new funding models and to make hard decisions about what the public system is really willing to cover. At the moment, government -- and I use that in the lowercase-“g” sense, because it’s governments of all stripes -- all of them hide behind saying “We have the best medical system in the world, and medicare is being threatened!” This is not about medicare being threatened. This is about making it work over the next 50 years. It’s done a reasonable job for 50 years but it is not sustainable.
Can you give some specifics on the kinds of effectiveness and efficiency improvements you have in mind? I know Dr Ouellet mentioned Advanced Access.
He stole my example! But Advanced Access is not just limited to primary care. It is not just about family docs. For instance, there is a urology clinic here in Saskatoon that uses it. The principles of Advanced Access do apply, can apply, to specialists' offices. And one of the hidden inefficiencies in our system – and I deliberately use the word “hidden” -- is no one is quantifying and talking about things like wait times between my decision to refer a patient for a non-urgent or mildly urgent – if you know what I mean -- to a specialist and when that specialist actually sees the patient. For example, if I see an elderly patient in my office this week, as I did on Monday, and I make an initial referral to have one of the orthopedic surgeons see her about changes of arthritis in her hip, thinking that somewhere down the line she might be a candidate for a hip replacement, it's going to be, who knows? Six months? Nine months? 12 months before that patient is even seen? Then she gets on the list to have whatever diagnostic tests need to be done over and above what I've already done, and then she gets on a surgical wait list. And no one is out there measuring, because it really can't measured because we have no way of capturing that data – you know, what's that timeframe between family physician assessment and the specialist? How can we help the specialist to improve management in their offices to match the improvement that family physicians and trying to make?
There are a whole different set of access problems for emergency care, of course.
And of course what it's resulting in is a domino effect of everything. You've heard about the domino effect of patients not being able to be discharged appropriately from hospital, so that plugs the acute care beds, so that then puts pressure on the emergency room and you can't admit patients. There's another domino. Another domino is the domino of what happens when doctors know their patients are waiting way too long for specialist consultations: they end up pushing the urgent button as a mechanism to get their patients seen more expeditiously. There are things that we as physicians can try to do. And some of these are answers to a fundamental shortage of human resources. We don't have enough bodies on the ground so we have to find a way to make the bodies that are available to us able to do their jobs more effectively, and effectiveness is the second thing I want to talk about. That's where the quality agenda comes in. So, are there things we can do that would improve the quality of care that we are offering? There are organizations like the Saskatchewan Health Quality Council – and I know there similar bodies for the other provinces – that are looking at those questions and saying, “Here, look, here's an example in post-miocardial infarction care where we can give you some specific pointers on which interventions and what to do to be effective in looking after these patients.” Certainly in primary care we have models out there for chronic disease management, for hypertension, for heart failure, for diabetes management. Those are quality initiatives, and if physicians are able to take the time to step back from their own practices and look at what they are doing and implement some of these suggestions, then that's another way of improving the quality of care.
You have mentioned more than once, I believe, that you’d like to de-emphasize the public-vs-private aspect of the health reform question.
It's a surrogate for scaring patients, you know? I mean, let's tell people [sarcastically] their healthcare is being threatened because the doctors are bad people and want to bring in the private sector. That's simply a scare tactic. We have to engage the public to say, “Look, folks, here are the real costs, here is the real situation. You want your care. How do you want it paid for?” And of course the cop-out answer is “I always want it free and I don't want to pay anything.” Sorry! We all know that's not sustainable. And we all know that models in other countries – wherever we're looking at things where there's a single route, then those models are failing.