An acquaintance named Jim recently died. He was not a personal friend of mine, but certainly was a friend to some who are. Regretfully, however, the story of the events that preceded his demise is one that recently is becoming all too familiar. You see, Jim had been a member of an HMO.
It all started one year ago in August when Jim complained of heartburn and shortness of breath. His primary care provider physician performed a cursory examination, told him his condition was due to GERDS and sent him home. Unbeknownst to the examining physician, however, a physician’s assistant had taken an X-Ray that was not noticed in the chart until a subsequent exam conducted some months later for the same condition. When it was noticed, however, the physician exploded, not because of what the X-Ray indicated, but because it had been taken without his authorization. Only because it did exist, however, was the physician able to determine that Jim’s problem was not GERDS, but rather was caused by the presence of a very large gallstone.
They scheduled an outpatient procedure to remove the stone and told Jim he would be fine. Then another mistake was made. It seems that someone forgot to pass certain critical information about Jim to the surgeon prior to the procedure causing Jim to have a heart attack during surgery that his family claims was not discovered for nearly a week after surgery. Following its discovery, however, they admitted him to the coronary care unit for awhile, but then quickly said he was good and again released him too soon to go home.
Jim was home just a couple of days, however, before he was rushed back to the Emergency Room. Again, he was having trouble breathing and was seen by his HMO provider group’s physician. If it hadn't been for a “real” physician from outside the group who was called in for consultation, however, I am told they would never have figured out what was wrong. Not only had he had a couple more heart attacks since being turned out, but it also turned out he had some type of fibrosis in his lungs. Yet, amazingly, even with these eventually discovered conditions, his wife relates how Jim was told repeatedly to go home by physicians from his HMO provider group. They told him he was fine, to get up and walk out. This was repeated multiple times daily, contrary to even basic common sense! Eventually, it got so bad that Jim and his wife complained to someone working for the State of California who ultimately stepped in to prevent Jim’s eviction from the hospital!
The HMO physicians then apparently re-channeled their energies to sending him to Los Angeles for “rehab”. But, then even that option was withdrawn and, ultimately, he was dismissed from the hospital but yet again as “doing fine.” Twelve hours later, however, Jim’s family again had to call 911 as he couldn't breathe. Once more, they took him to the hospital where he wound up in Coronary Care. This time, however, they told him he also had kidney failure. His family maintains today, that was when the HMO sent in their "Terminator" doctor who told them there was no longer a choice; he had to leave the hospital and go home for hospice care, as he had now been designated as a terminal patient. Conveniently, this designation also just happened to relieve the HMO of any further responsibility and/or liability for his future medical care. And so, Jim’s HMO dropped him as soon as the terminal diagnosis was given by his group's "Terminator" doctor, leaving hospice care as his only chance for life. Jim died within two weeks … at home.
Needless to say, these events caused his family to have questions. Was he really terminal all the time and this was just his time to go, or was his death caused in large part by a lack of competent medical care provided by his HMO’s physicians due to cost concerns? Were they so worried they'd have to pay a bill arising from competent medical care that the HMO wanted rid of him? Would rehab or an earlier proper diagnosis of his medical condition have cured him or, at least, prevented his condition from worsening? Who knows? Certainly his family never will.
When members of Jim’s family attempted to get copies of his medical records they were told that certain critical portions of them seem to have been misplaced and couldn’t be found. They also discovered that certain physicians who were directors of the HMO’s provider group were also on the boards of the hospitals involved in treating Jim. Convenient, some would say. Then malpractice attorneys were eventually consulted. They declined the case, however. The family was told that because there was a low dollar limit for general damages in malpractice cases and because of Jim’s age there weren’t likely to be sufficient special damages such as lost wages, it would not be worth pursuing.
The conclusions drawn by Jim’s family from this experience are the following. Without lawyers to corral them, some doctors seemingly have free reign to determine the course of your medical treatment based on economics rather than medical ethics. And, why shouldn’t they? The way our medical/legal system is structured, after a certain age human life has been predetermined to have no value, with the result that any malpractice visited upon the aged has no practical adverse consequence for the physicians involved.
The result? It would seem that under some HMO care, if the HMO’s assigned physicians decide its cheaper for the HMO for an elderly person to die rather than live, so shall that patient’s fate be determined, regardless of the efforts and pleas of both the patient and his loved ones to obtain a more favorable result that may be medically feasible and available. And so, it is in this way that the value of life is cheapened in pursuit of the dollar. Some may think that appropriate, while others may only see it as a sad commentary on today’s culture.
Others, however, may be left angry and wondering if physicians are permitted to practice in this manner with impunity why was Kevorkian ever imprisoned?
© 2005 Clifford C. Nichols
Cliff Nichols is an attorney practicing criminal defense/entertainment law in Santa Monica, California. He may be contacted regarding this editorial at either (310) 917-1083 or www.cliffnicholslaw.com or you may join his blog at www.thedailystand.com
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