Tuesday, July 15, 2008

How Preposterous!

Tuesday's Tirade
A Tall Tale

Carelink Health Plan awaits judgement.

"Even the most upright people are apt to become dishonest and unmindful of their civic responsibilities when placed in a typical corporate environment . . . . The culprit is not personal value but corporate culture . . . . People's personal values are getting blocked by the needs of the corporation" Christina R. Salem and Tom Stickel

Recently I received a copy of Carelink’s spring newsletter, Livingwell. The following announcement projected a strong, public image, an image that is very far from what I have personally experienced:
Carelink Awarded Excellent NCQA Accreditation http://www.freewebs.com/courageoffaith/Carelink%20Awarded%20Excellent%20NCQA%20Carelink%20Accreditation%20%20at%20%20BNET%202008.mht

As you know, there is always more to any story. Someone may not be happy with my storytelling. It takes courage to face the truth.

It’s all in the appearances. The image. Criminal behavior oftentimes is masked behind a corporate suit. A suit that promotes a high degree of integrity in the business it does.

It’s all there in the many brochures and advertising pieces. We see. At first we believe. However, in time we know we are foolish, really foolish. We follow the directives of our health care plans like sheep led to slaughter.

Only when one begins to look under the layers of advertising and helpful voices of customer service and executives, one may begin to notice the smallest of cracks. A stirring within one. A sense that something is not quite right.

Coventry Health Care Inc., parent company of my HMO Carelink Health Plans of West Virginia, “welcomes” you in bright blue letters to its website cvty.com with fine words. Notice how these words are chosen very carefully:

What makes us unique in the competitive health benefit marketplace? We focus on doing the basics of our business better than other companies by maintaining financial security, upholding high quality standards, promoting provider choice, providing superior customer service and being innovative in all areas of business. We commit to do all of this with the highest degree of integrity. (My emphasis)
How preposterous! Completely contrary to the Coventry I experienced too many times during the past three years, from June 2005 through January 2008.

This most recent promotion of Carelink Health Plans, Inc. of West Virginia as having been awarded an "Excellent" rating from The National Committee for Quality Assurance located in Washington, D.C. is alarming.

Think back to Final Order 06-AP-024 of the West Virginia Insurance Commission against Carelink on December 14, 2006. http://www.freewebs.com/courageoffaith/2006%2012%2014%20Final%20Order.pdf

Think back to the ruthless letter Patrick W. Dowd sent me on November 1, 2005. http://www.freewebs.com/courageoffaith/2005%2011%201%20Letter%20from%20President%20of%20Carelink.pdf

The Civil lawsuit that was filed on October 15, 2006, in Ohio County, West Virginia, against Carelink and Dowd. http://www.freewebs.com/courageoffaith/2007%2010%2015%20Civil%20Lawsuit%20Filed%20Stenger%20v.%20Carelink.pdf

How many of us would be so foolish as to describe Carelink as excellent? So how did this happen? How could so many be apparently duped?

July 1, 2008. I spoke with Miss "Barbara" in the Customer Service Department of NCQA, the accreditation agency. We discussed the implications of NCQA’s recent certification of Carelink. Was it shock I heard from Miss Barbara?

It is the policy of NCQA to make an evaluation of a health plan based on "voluntary" information to a survey. Did the "team" speak with the WV Insurance Commission? Did they look into current court dockets? Disregarding the fact that NCQA collected "voluntary" information per their policy, the conclusion NCQA drew is terribly flawed. A significant rating was awarded based on voluntary information. Why? What responsibility does NCQA take in this deception? Are there other health plans seeking accreditation with certain questionable records not brought to light?

So many questions to be answered. It's a pretty sick situation in my mind. Pun not intended. So senseless. So unreasonable. So abhorrent.

Is it a warning of future danger? A call to arms? The pendulum is about to swing in our favor of we victims. If it doesn't, this country will be in far worse shape than any of us can imagine. For by remaining quiet, we invite grave danger into our midst.

I just now came across this information on the web that will show you how far one can go to develop an image. Is this being honest or dishonest?

West Virginia
West Virginia does not produce its own HMO report card, but you can read about health plans in the state via the NCQA's Health Plan Report Card. You can search for health plans to compare by zip code or by state, and you can ask the tool to compare only certain types of health plans—for instance, only Medicare HMOs or only PPOs or all types of plans at once. The site explains how to use the NCQA report card results.

You will find this infomration on the website of AARP, its State-by-State List of HMO Report Cards Online.

Tuesday's Tale
She's Dead. Yet another one.

DEATH BY HMO: The Jennifer Gigliello Story
Death By HMO (a new book based on a true story) was released November 1999. For more information, contact the publicist, Robert D. Reed. Phone: 1 (800) IDEAMAN;Email: 4bobreed@msn.com. Reviewed by Kismet Oz

Perhaps there is no greater regret than when you choose one direction over another, then at the end of a long and difficult journey you realize you've made the wrong decision and paid the ultimate price. This is precisely what happened to Jennifer Gigliello and her family, who relied on a medical system that was supposed to deliver appropriate care and have the right answers, but did not.

In Death by HMO: The Jennifer Gigliello Story, written by Jennifer's mother, Dorothy Cancilla, a powerful story is shared which serves as a lesson to all who read it. Unfortunately, this story could happen to anyone or their loved ones.

Jennifer was only twenty-two years old when she experienced medical problems during her pregnancy. She had severe pain in her abdomen. After the birth of her son, the pain returned. Jennifer's family consulted a specialist who believed that her gallbladder was causing her pain. He recommended that she have her gallbladder removed. The family believed that Jennifer was too young to have this type of surgery. They sought the second opinion of a doctor who was recommended by a family friend. He concluded that Jennifer's pancreas was the source of her pain. The family came to regret trusting in this second doctor's diagnosis. This was the doctor who was responsible for setting in to motion an odyssey of endless hospital stays, emergency room visits, and dangerous surgeries that would plague the entire family's lives for the next eight years.

The Cancillas have been and remain a very close family. They shared in Jennifer's suffering through excruciating pain and complex medical procedures. They marveled at her will to lead as normal life as possible during her brief "vacations" from illness. Her spirit and yearning for a full life gave the family strength.

Jennifer eventually gained medical insurance coverage under one of the largest HMO providers, Kaiser Foundation Health Plan of Northern California. Severe pain caused Jennifer's increasingly dependence upon painkillers. Throughout her ordeal, doctors and the hospital staff never grasped her extreme suffering. They persisted in only treating her symptoms rather than exhausting all measures to find the underlying cause of her illness. Treating her symptoms involved providing high doses of painkillers. Ironically, as her illness progressed, medical staff admonished Jennifer for her dependency on drugs and treated her with disdain because of it.

Jennifer's illness led to frequent hospitalizations and complications, including severe malnourishment. After further surgeries, she became an insulin-dependent diabetic. With a severely damaged digestive system and malnourishment, Jennifer's illness became increasingly difficult to manage.
To try to remedy Jennifer's medical condition a highly specialized "Hickman" catheter was inserted. This treatment required special attention because the risk of infection was high. Jennifer received instruction on how to clean and operate the catheter apparatus. Unfortunately, the medical staff supervising her care failed to follow oversight procedures for patients with this type of treatment. She suffered frequent episodes of infection.

Jennifer's family was disturbed to notice that the hospital staff treating her had no training for the catheter on which she relied for nourishment. The family thought it was ludicrous when the staff in charge of treating her asked Jennifer to come to the hospital when she was feeling better and "train" them on the cleaning and operation of the "Hickman" catheter. Although proper procedures were established for the maintenance of the catheter, the staff at Kaiser never received the training. The most vital part of that training would be to readily recognize signs of infection.

As Jennifer's hospital visits became commonplace so did the attitude of those in the emergency room. When her regular doctor was unavailable, her treatment was inconsistent and often lacked even the most basic aspects of proper care. The family concluded that the HMO viewed Jennifer's illness as "not cost effective"; therefore, treating her was inconsistent with a healthy bottom line.

During the last year of her life, Jennifer was admitted to the hospital countless times. She experienced fevers, delirium, and weakness. She had developed a severe infection from the catheter, which had advanced to a gravely serious level. Various doctors and nurses at Kaiser failed to recognize the infection -- despite knowing that a catheter patient with a fever should be assumed to have a catheter infection. With all of Jennifer's medical records available, including her long history of catheter problems, the Kaiser staff should have been able to diagnose and treat the infection. However, they decided against replacing the catheter immediately because that would have cost Kaiser about $10,000. Evidently, the staff tried to delay replacing the catheter in order to save money.

Jennifer's doctor at Kaiser had been out of town during the critical time when her serious symptoms were overlooked. Later, he told her husband some shocking revelations. He said, "I had been worried that Jenny would not get the proper care while I was gone. [since] no one at Kaiser wants to treat her because she is so sick." He said he had ordered Jennifer's medicines in advance because "No one wanted to treat her unless they had to."

This is the same doctor who shunned the family after Jennifer died and refused to keep his promise to discuss her autopsy report with them. He is the same doctor who, rather than offering condolences to the family at Jennifer's deathbed, ignored the family and went to his office to fill out the "paperwork."

Following several years of arbitration (required by contractual stipulations between Kaiser and its HMO members), the family received an award of $175,000. This is only a portion of the maximum of $250,000 allowed -- yet Kaiser was found to be solely responsible for Jennifer's death. The full award was not provided because the doctor testified that he estimated that Jennifer would have lived only another three to five years. This revelation stunned the family because no one ever indicated that her illness was considered "terminal." It is more profitable for HMOs to allow chronically ill patients to die rather than to care for them properly. Patients' premiums are relatively low and taking care of the chronically ill costs thousands of dollars per month. HMOs stay profitable by treating illness on a short-term basis. Repeated hospitalizations of patients who are chronically ill become financially draining. Herein lies a serious conflict of interest.

Jennifer's family hoped that the war they waged against Kaiser would have forced the HMO to institute changes in the ways in which they handle patient care. Unfortunately, it has been found that a large number of wrongful death suits have been brought against Kaiser in the ensuing years since Jennifer's death. They continue to endanger patients' lives through excessive cost-cutting measures. Death by HMO was not written for vindication. The author, Dorothy Cancilla (Jennifer's mother), writes with strong conviction that their family story should never have to be repeated. She advises readers to take full responsibility for their own care and for the care of loved ones. Mrs. Cancilla includes excellent resources for doing research on various illnesses. She encourages people to line up advocates, who will take charge of treatment plans, do research, find information, ask questions, and explore various treatment options. There is a proliferation of HMOs, where diagnostic tests, treatment options, and life and death decisions are made by corporate bodies instead of medical doctors. The corporate focus on the bottom line creates an environment of negligence. It is time to examine the way HMOs operate.

Mrs. Cancilla is willing to share her painful story so that the rest of us can learn to prevent similar tragedies. Doctors and the medical establishment might learn something as well.

Death by HMO is available in hardcover for $23.50 (includes shipping & handling. Order from: Dedicated Press, Box 1638, Pacifica, CA 94044.

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