Guaranteed Healthcare

We were members of a large HMO. My husband presented to the urgent care with bronchitis. A chest x-ray showed cardiomegaly (he is an athlete). An electrocardiogram indicated he was in third degree heartblock. He was transported to the telemetry unit at the hospital for observation overnight. He received an echocardiogram the next morning which showed no cardiomyopathy. The Cardiologist diagnosed him with second degree Wenkebach and released him.

My husband suffered for 14 months feeling lousy, unable to exercise to his full capacity, and was very irritable. Fourteen months after the diagnosis of second degree heartblock, he had a near syncopal episode. Back in the emergicenter, the electrocardiogram again showed third degree heartblock. The cardiac enzyme troponin was slightly elevated. He now was transferred to the Hospital Cardiac Care Unit, had serial cardiac enzymes (which in the hospital's lab were all normal, compared to the HMO's lab).

He had an angiogram (100% clean). He had a pacemaker inserted and was discharged on the fourth day. He had not had an MI, no coronary vascular disease, just untreated third degree heartblock. I saw a copy of the bill for the CCU- $37,000 dollars (which we didn't have to pay). I had the cardiologist review his electrocardiogram from 14 months previously. Not only was he definitely in third degree heart block back then, but they were using his EKG from that visit to teach ACLS to the emergicenter staff.

Had they put the pacemaker in initially, he would not have spent a miserable 14 months, nor would he have developed atrial enlargement and labile hypertension from untreated third degree heart block. Let alone the savings to the healthcare system from doing it right the first time.

Now, on to my mom. She presented to a large HMO ER with acute hip pain (she was a previously very healthy 87 year old active artistic woman). They did an xray and said she needed her hip replaced, but there was a two month waiting period. She couldn't walk, so she stayed mostly in bed, developed deep vein thrombosis and pulmonary emboli. She was admitted two months after the initial ER visit. She was anticoagulated and they tried to control her hip pain.

After I spoke with the attending doctor about her pain, they did an MRI and found a missed old femural fracture and avascular necrosis of the femoral head. She had to be taken off the coumadin, put back on heparin (she had already had a filter placed in her inferior vena cava), and scheduled for surgery in haste. After a successful hip replacement, she went into hemorrhagic shock in the recovery room, was fluid resuscitated and went into congestive heart failure. She basically never recovered and died one month later.

The hemorrhagic shock was caused by the recovery room nurse giving my mother Heparin, instead of Hespan (the medication to reverse heparin). They didn't detect the mistake until after she was resuscitated and in the ICU. Standard of care states that an elderly patient with hip pain needs an MRI (a more expensive test), not just an xray, to detect fracture which can be from a fall, or simply a stress fracture. Had that been done, my mom probably would have had her hip replaced quickly before all the complications developed in her cardiovascular system. She'd probably happily be writing or drawing in her studio right now.

Interestingly, in California there is a cap on pain and suffering for the family to the tune of $250,000. If my mother had lived, and been disabled, there would also have been economic damages to help care for her. In California, malpractice attorneys are not taking cases in which the patient dies, because they can't make enough money. The malpractice insurance companies profits have gone up 30%. It is to the healthcare system's advantage to let a patient who has been the victim of malpractice die. It is more cost effective. I believe this is allowing more negligent and sloppy healthcare. It's very frightening.

The bottom line is that the healthcare system is overstressed, understaffed, and undercompensated. Health and Malpractice insurance companies are laughing all the way to the bank. Health insurance companies and managed care are causing shortcuts that are leading to disability and death. And in some states, like California, families have very little recourse. If doctors didn't have to worry about adequate compensation, and physician profiling (which is becoming increasingly more common with on-line charting and ordering in large group practices and HMOs), and could use their knowledge, experience and practice the 'art of medicine', we'd all be better off.

The single biggest factor is the amount of time a physician or provider can spend with a patient. An ounce of prevention is worth a pound of cure-being able to listen to the patient, go through the medical mind's list of possibilities and ask more questions, as well as having the time to check a reference book or two. I recently learned that several of my colleagues have quit practicing medicine because of the restrictions, stress and cyber space monitoring of their practices. Who will be left to care for all of us baby boomers?