Guaranteed Healthcare

My story is minor compared to others, who have suffered far more severely as a result of poor health care. However, it's significance is more about demonstrating that even so called HMOs, which are both, employer & employee paid, can & do provide sub-standard care.

First, the history: I am basically a healthy 59 y/o (RN, BSN, of 32 yrs experience), w/ h/o total abdominal hysterectomy 18 yrs ago, so unable to produce own estrogen for osteoporosis prevention. Took HRT estrogen d/t severe chronic debilitating hot flashes & having a mother w/ h/o severe osteoporosis. Have been off HRTs x1 yr d/t other family h/o cardiovascular disease; personal h/o fibrocystic breast disease/potential breast cancer risk; h/o left leg peripheral vascular insufficiency combined w/ lymphedema & h/o phlebitis, same limb all believed to have resulted from compromise caused from prior h/o blunt traumas x2 & knee surgery.

For self care, I take recommended doses of Calcium w/ Vit D & power walk minimally 1-3 mi/day, plus do additional brisk walking on job as RN. I change sitting/standing positions as frequently as possible to avoid circulation compromise/severe dependent edema. I limit my salt intake & spend most evenings elevating my legs above my heart.

On 11/14/07 while brisk power walking downhill (on asphalt), I twisted my left ankle causing loss of balance. In attempt to break my anticipated fall, I struggled to regain balance, forcing hyper- extension of my left great toe. Attempt was unsuccessful, resulting in my landing on left knee causing blunt trauma one more time to that poor knee. I felt & heard a cracking sound in my left great toe. Of course the knee swelled to twice its normal size, causing circulation concerns, but the toe concerned me more.

The swelling & pain were effecting my mobility. I am my sole support & must continue to work to survive. All family is deceased, so I have no one to help w/ financial emergencies. The next day, I did as Kaiser HMO insurance instructed. Called advice nurse, reported nature of injury & requested referral to closest clinic for appropriate care. Their policy is to go to your primary care physician (mine's an Internist) & if warranted, they will refer to a specialist.

When I arrived at her ofc., she wasn't available, but I was told I'd be seen by one of the NPs, an Adult Family Medicine practitioner. I never saw her. An office RN was the only one who saw me that day. She assessed the toe & knee. After reporting my complaints & her findings to the NP, I was directed to radiology. I returned to the office awaiting the NP's x-ray review & asked for a walking, or ankle splint/post op shoe/some type of solid support to stabilize the toe, preventing it from bending. The RN returned, telling me the NP didn't see any fracture & they refused to give me any foot/toe support at all.

I knew the toe would swell beyond my ability to get into regular shoes. I attempted to tell them I have ortho/trauma/ER & surgical experience in addition to prior injuries, but she argued with me, stating 'we don't give any support for soft tissue injuries.' She then proceeded to give me appropriate written instructions for elevation, ice & to stay off of it for about 3 days, along with a prescription for 40 Vicodin!

I did as I was told, knowing I had to allow for healing. Regardless of their proclamation of no fracture, I didn't totally buy it, but felt grateful it wasn't & returned to work in 3 days. About 1.5 wks later, the toe became pinker, more swollen, & painful. I called to say that I needed more help & needed re-assessment. Later this same day I received an x-ray report copy from the radiologist, confirming there was, indeed, a fracture.

When I arrived atmy PCP's office again, she wasn't available, so again, was seen this time by a different RN & was actually seen by an NP. She wanted to argue with me that it wasn't broken. I asked if she'd read the radiologist's report. She had not. After she did, I finally got some support -- a half-used roll of 1/2" tape & a post-op shoe. This was the most uncomfortable support I could have had, but it was all they'd give. It didn't protect the toe. It stuck out of the shoe. Luckily, I didn't drop something on it, but it just as easily could have been re-injured. However, it did offer solid support under it, so it was better than the alternative of nothing.

In order to walk safely at work, for 2.5 wks, I had to tighten the velcro straps so tight it cut into my foot's circulation...not what it needed. I then found Crocs to be the only wide enough toe box to tolerate for several more weeks. Finally, 7 weeks after the date of injury I was able to put my foot into a normal shoe. I lost much time & suffered unnecessarily thanks to their incompetence.

I thought the new progressive approach to medicine was treating the patient as the most important member of the health care team... & what happened to listening to the patient? Especially one with more knowledge & experience than the providers in the specialty of orthopedics & trauma! I had also just adopted an adult dog, who'd been re-homed 3 previous times & was in the process of establishing a bond of trust. She had to be returned to the original owner for several weeks because I could barely care for my own needs, let alone a 40lb. dog needing much reassurance. Thank god, she returned & we've been able to pick up where we left off.

Oh, those 40 Vicodin? In recent years, my RN experience turned to mental health issues. I have worked in chemical dependency treatment, specializing in helping health care pros regain their lives, their self respect & practices, after becoming addicted to pain narcotics, like Vicodin. I both laughed at the thought that I would need such a number to get beyond the painful stages of healing (I only needed 20 even with their screwed up set back of incorrect x-ray interpretation), but was appalled, as well, that she'd prescribe that many without monitoring how many I truly needed. Wow, is it any wonder we have so many people struggling w/ addiction? Sorry, I digress to another major issue in our health care system.

The saddest part of all this, is that those of us who dedicate our lives to serving others in our screwed up health care system, feel doubly betrayed when we get less from it than we give, or deserve. Geez, we've got to fix it, before us Boomers get to where we're needing it more...because we WON'T be quiet about it being crappy!!!