Today President Obama called health care reform the “defining struggle of this generation.” Why? Amid all the complexity and red herrings of the seemingly never-ending debate over the legislation currently wending its way through Congress, it may help to delve into the belly of the beast via first-hand accounts of those unlucky enough to meet up with the system at its worst. These extracts have been edited for spelling, grammar, and length. A list of sites from which they were taken can be found at the end of the text. Part I and Part II of this series here.

My dad was having shortness of breath and a low blood pressure and was being transferred to the ER of my managed care organization.

So a man is admitted to the hospital for congestive heart failure and they discharge him after 36 hours?

Is a life not worth more than the cost of 36 hours of hospitalization? Does the almighty dollar really trump adequate medical care? What is wrong with this country?

My mom found out that when they discharged him from the hospital they had noted on the forms “possible viral pneumonia.”

Congestive heart failure and possible pneumonia and they discharged him!

An upper-level employee of my managed-care organization explained to me why they will not help Lyme disease victims. The company views Lyme disease in the same context as AIDS, only Lyme disease is far more common and the risk exposure far greater. AIDS has been and is a large cash drain for the company and they don’t want to repeat the experience. So their solution is to severely limit diagnoses.

One method used by ethically challenged HMO’s and health insurers to discourage extended treatment is to file anonymous complaints to state medical boards against doctors who “overdiagnose and overtreat” Lyme disease.

And one of the many reasons the company fails to diagnose some cancer early is that they have the chutzpah to change the generally medically accepted value for normal on test results so as NOT to find illness. They use a lower hemoglobin for their definition of anemia than is accepted by every other source I have found, for example.  By expanding the definition of “normal,” they reduce the amount of illness (they have to pay for).

I recently worked 18 months in the emergency room of this managed care organization in Fresno. The idea that decisions are in the hands of the individual treating physician and the patient is a complete hoax. Here are some experiences I had:

• pharmacists will change physician prescriptions without notifying the physician who wrote it
• ultra sound simply went home at 5 p.m. with no backup — so how could this test even be ordered?
• hospitalist internists would routinely send home patients that board certified emergency physicians thought needed admission
• the same internists would then be pressured by utilization review to discharge unstable patients — one patient dying in the middle of the hallway argument about discharge just outside his room
• excessive ordering would be punished by passive aggressive delays in giving back tests results — one physician watching a TV football game rather than reading an emergency CT scan
• IVs ordered by physicians to be continuous would routinely go dry from lack of attention to empty IV bags

Those physicians who stay have been brainwashed into accepting compromised care or are self-described “slaves” working unpaid hours into the night trying to do the job right. Even the physicians inside have complained in an internal newsletter that the $100 million per year spent on advertising might better be spent on patient care.

On Saturday I suffered abdominal pain so extreme that all I could do was literally scream. I called 911 and was rushed to my managed care organization’s ER. The doctors gave me morphine, which had no effect. On a scale of 1 – 10 , the pain remained an unbearable 10. They then administered another drug that had some effect and reduced the pain to a 7.

During the night I received a CAT Scan that found no visible sign of trauma, injury, or threat to vital organs. But so extreme was my pain that I pleaded with the doctors to find me a hospital bed so I could stay. Some of the doctors on duty agreed that I should be kept in for further observation and tests to ascertain the exact cause of the pain. One of the doctors that examined me tried get the OBGYN on duty to come and see me, but the OBGYN literally refused.

Later that morning another doctor appeared and obviously had already concluded that I should not stay in the hospital. He stated that there was nothing they could do and that the best route going forward was ‘pain management.’ I was too sick to disagree and instead signed the release papers so I could go home and try to sleep. A friend took me to his car in a wheelchair because walking any distance was an impossibility due to my being bent over with the worst pain I have ever felt.

I arrived home and managed to get some sleep, but a few hours later the pain again became so intense that I was vomiting violently and blacking out. In desperation I asked one of my co-workers to take me back to the ER of my managed care organization. After sitting in the waiting area for 5 hours I was admitted, placed on an IV and administered more pain medicine. 3 of the 4 doctors who examined me throughout the night agreed that I should undergo a laparoscopic exam. The last Dr. who looked at me requested that the OBGYN on duty examine me. Once again the OBGYN literally refused and I was instead referred to the pain clinic, discharged and sent home. I pleaded with the discharging doctor to perform a laparoscopic exam on me and to let me stay in the hospital. He refused, and moreover, he would not offer a good reason why.

Yesterday, I called my physician and begged her for an appointment with the OBGYN at a different center.  She managed to secure an appointment. Upon examination, the OBGYN concluded that there was nothing he could do for me. I asked him to refer me for exploratory surgery, and he stated it was too risky. I asked him why and he said such surgery could damage the small intestine, due to my low body-fat ratio.

Once again, I was sent home with yet another script and still in terrible pain.

Today I was so dehydrated and in pain from constant vomiting that I had to call 911 yet again.  I was taken this time to a different managed care center. The ER doctor put me on drips then told me there was absolutely nothing they could do and that I would have to live with the pain. He also referred me to pain management and discharged me despite my now very desperate pleas to be kept in for further tests.

I cannot understand how this company can reject a very sick person by not exhausting all avenues in the form of tests etc, before concluding there is nothing they can do. Surely it is the duty of all doctors to try their utmost to help the patient – when one test shows nothing, that another should be conducted until a conclusion that is based on due diligence is arrived at.

Do you know how terrible it is to be treated like this?

Cited sites:

* http://www.kaiserthrive.org/kaiser-permanente-horror-stories/
* http://horror.kaiserpapers.org/
* http://cigna.pissedconsumer.com/
* http://www.consumeraffairs.com/insurance/cigna_health.html
* http://www.consumeraffairs.com/insurance/aetna_health.html
* http://aetna.pissedconsumer.com/
* http://consumerist.com/

Posted on September 17, 2009 at 2:13 pm
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