Think Medical Care Is Bad in This Country?

If you think access to and quality of medical care in America leave something to be desired — as I occasionally do — you’d better take a look at this. Particularly interesting is the long, long round of reader comments, which suggests this horrifying story is hardly an isolated incident. Makes things here look a lot better, by comparison.

Now, I will say the fact that Britain’s National Health Service apparently isn’t great, even if you have influence (if not money), doesn’t change the fact that care is not always easy to acquire in this country and certainly isn’t affordable for anyone who doesn’t have a full-time job with a good insurance policy.

Over 35 years ago, my mother died under circumstances not unlike those MP Ann Clwyd describes. She was in Arizona’s first HMO, an arrangement that looked like a bargain to my father, who retired before he and my mother reached Medicare age. At that time it was still too early for people to understand exactly what sacrificing a choice of doctors means.

The HMO was set up to provide a financial incentive for doctors to avoid delivering care that was likely to be expensive. As a result, her doctors simply refused to acknowledge anything was wrong with her as she was dying of cancer, a condition obvious to anyone who knew and observed her. We couldn’t get her to another doctor, because my parents were trapped in the HMO, and so as she lay on her deathbed we were told she was a mental case.

After we finally persuaded her quacks to perform exploratory surgery and she was found to be full of inoperable cancer, she was left to rot in a nursing home near Sun City, in the most hideous conditions imaginable. Just to get them to clean her up as she lay in her own stinking fluids, I had to threaten to call a lawyer — literally, only when I told the doctor’s front office staff that my next call would be to my lawyer did he show up and order the listless nurses to change her sheets and clean up the mess.

After that I managed to get her admitted to a better nursing home in Phoenix, but it meant my father had to make a 40-minute drive every day to be with her. He insisted on doing so, because he realized that the only way to see to it that even marginally adequate care was delivered was for him to sit there in her room from dawn until after dark.

The HMO, which was run by Blue Cross/Blue Shield, fought the nursing care every inch of the way. We managed to force them to cover most of the cost because she needed skilled nursing care — heavy-duty, addictive painkillers had to be administered by injection, plus they’d stuck in a tube to drain her abdomen and a tube to drain her urine — and that was the only reason we could get her into a nursing home.

My father was unable to care for her; he was an elderly man who couldn’t lift her, he was in no condition to administer injections, and she would get up in the middle of the night and stagger around, dazed, in the dark, crashing into furniture and injuring herself. They tried to claim she really didn’t need this care, and to prove it one of the HMO doctors ordered the nurses to mash up morphine pills and stuff the slurry down her throat. This wasn’t very successful, because by then she was on the verge of coma. On the day that she died, they were going evict her from the nursing home, because, they said, she really didn’t need any care.

The upshot of all this, for me, was that I was unable to be with my mother in her dying days, because I literally spent all of my time fighting with the medico-insurance bureaucracy. I lost track of how often I uttered the words “would you like talk to my lawyer.” I would go by the nursing home once a day, but there was no way I could sit at her bedside all day, with so much battle to be done.

In my observation, things have not changed much for the better. The guy who sold SDXB his house here in the neighborhood did so because he was dying of a cancer that went undiagnosed by HMO doctors who kept telling him the swelling in his neck was an infection; he knew his wife couldn’t handle the place, and he needed the money to cover the medical bills. Same thing happened to a colleague’s wife: for over three months, her HMO doctors treated her fulminating breast cancer with antibiotics.

Even for those who have managed to avoid HMOs, access to medical care can be iffy, at best. Quality is too often questionable.

Several days ago, I called the Mayo to ask for an appointment with an orthopedist, since the back pain and plantar fascitis haven’t cleared up. The woman I spoke with said she’d ask my internist for a referral and shunted me off the phone. I’ve never heard another word.

I have the name of an orthopedist from Young Dr. Kildare; however, if you let your name slip off the rolls of the Mayo for a year, you get “fired” as a patient. They don’t want to do business with Medicare, and so if you’re on Medicare, you can’t get in at the Mayo. If you were already a patient at the time you went on Medicare, you get grandfathered in (at least, for the time being…that may change), and since the Mayo is best game in town (they saved my life after St. Joseph’s ER ignored me when I showed up with advanced acute appendicitis), it’s in your interest to show up over there once a year. This looked like a good opportunity for the annual visit.

Meanwhile, I needed the name of an ophthalmologist — an MD, not an optometrist — having experienced stabbing pain in an eye. Called YDK’s office: they didn’t have a clue. They referred me to a guy I stopped seeing years ago, after he told  me, incorrectly, that he believed I had a melanoma in one eye. That was after the time he told me he thought I had MS.

I may have MS, indeed. But I do not have eye cancer, something that was elucidated only after two fear-filled weeks of waiting to get in to see an oncologist.

The other day I fell, hit my head on a wooden chair, and walloped my knee. The bruising is healing up, but a sharp pain remains in the knee. So now I have even more reason to see an orthopedist.

Nice thing about falling on the tiles, though: it seems to have jolted something loose in the back, so the back pain is better. Doesn’t look very hopeful, though, that I’ll be able to hike anytime in the near future: probably not in time to get in shape for the day-long hike up Oak Creek scheduled for next April. Certainly not if the kneecap is fractured. Wouldn’t it be useful to know, though?