Medical, Regulating Healthcare

Regulating Healthcare

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PAIN #1 / 17	Regulating Healthcare ********* PAIN FORUM The following information is from the California Nurse's Association. CNA along with Ralph Nader and Harvey Rosenfield is sponsoring the "Patient Protection Act" on the ballot this November in California. The Patient Protection Act protects you against the greed of the HMO industry. For more information, visit our Web Site at http://www.**.com/ Please cross-post and forward this message. The following are excerpts from letters received from patients, their families, and Registered Nurses, in response to CNA's Patient Watch adverti{filter}ts and similar campaigns. These ads have appeared in many places, including the New York Times, Los Angeles Times, San Francisco Chronicle, Sacramento Bee, San Jose Mercury News, and other newspapers and magazines across the country and in Canada. "My grandfather survived brain surgery but died three months later, from the effects of malnutrition, dehydration and an infected bedsore. All of this could have been prevented if a registered nurse was at his side. He was a dignified elderly gentleman, a loving husband and the strong center of a family...In the hospital he had become just another dollar sign who was being manipulated to meet the greed of hospital revenue." My wife entered ----- hospital recently and received very poor service. Every time she called for a registered nurse, she got a "nursing assistant" or "patient care assistant" instead. It took 30 to 45 minutes to actually see a registered nurse. Our baby died after we were pushed out of the hospital too soon by ------ Healthcare. The coroner's report said our baby died of meningitis or streptococcus B, and would have lived if we had spent just 6-10 more hours in the hospital. Our child was born with a cleft palate that was not detected. She was then misdiagnosed as developmentally disabled. While we were in the hospital, we rarely saw an RN. When we went home, the baby was not feeding properly. The hospital where she was born was unresponsive and of no help to us. We finally took her to ---- Hospital in -----, where she was found to be dehydrated and had to be put on an IV. "I provide HIV antibody testing and counseling services. One of the clients I counseled required HIV antibody testing because she had cared for a relative who died of HIV disease and had given the relative several injections, during which she had sustained needle sticks. This client had no previous medical training or experience prior to caring for the ill relative. She told me she was awkward and nervous while giving the injections, and that was why she had sustained the needle sticks. "I am concerned that the standards of care may be deteriorating or ignored, allowing such terribly unsafe situations to occur." "In April of 1995, an aide removed an IV tubing from its IV pump. This was done to facilitate the patient's gown removal. The patient received 90mg of morphine in five minutes, and had to be rushed to the ICU. The patient did not die, but did suffer a major crisis." A 27 year-year-old man from Central California was given a heart transplant, and was discharged from the hospital after only 4 days because his HMO wouldn't pay for additional hospitalization. Nor would the HMO pay for the bandages needed to treat the man's infected surgical wound. The patient died. A four-year-old girl ran a high fever following a five hour hospital stay for a tonsillectomy (considered an outpatient operation by HMOs). Her mother took the girl to her HMO pediatrician, who didn't take the girl's temperature, didn't examine her throat, and didn't refer the girl back to the surgeon-- a routine procedure for post operative problems. The girl died of a hemmorhage at the surgical site. When a 23-year-old diabetic asked her California HMO why it wouldn't cover the cost of {filter} sugar testing supplies, the company's chief executive told a newspaper reporter that the company provides all benefits required by the state. He suggested that the patient "try to get a law passed requiring the kind of coverage she wants." A former HMO medical reviewer is still haunted by decisions she made to deny care to patients. She was quoted in a special report published in U.S. News & World Report: "If there was any way at all to claim that something requested was experimental or nonstandard, we took it. We looked for ways not to cover treatment" she said. Late last year a three-member arbitration panel awarded over $1 million to the family of a 34 year-year-old schoolteacher who died of {filter} cancer. A California HMO was the defendant. Testimony given during arbitration hearings showed that the HMO tried to "influence or intimidate" the woman's oncologist and his superior with "argumentative" phone calls. In the opinion of the panel, "(the) HMO's actions, which were designed and intended to interfere with an existing doctor/patient relationship, constitute extreme and outrageous behavior, exceeding all bounds usually tolerated in a civilized society." These are just some of the thousands of examples of how the current managed care system is failing to provide adequate and safe health care. As healthcare providers charged with the public's trust we need to continue to gather these stories to counteract the industry's claims that quality of care is "improving." The Patient Watch program will continue to be an integral part of our winning strategy for the initiative campaign. Please encourage everyone who has had a negative experience to submit their Patient Watch story to us by any of the following methods. Via mail addressed to: Patient Watch California Nurses Association 1145 Market Street, Suite 1100 San Francisco, CA 94103-1545 Via Telephone at: 1-800-440-6877 Via E-Mail addressed to: Also encourage people to visit our web site at: http://www..com/ ------------------ California Nurses Association ------------------ -------------------- http://www..com/ ; ------------------- ------------------------- 1 800 440 6877 -------------------------- There's only one way to make sure your family gets the best care from today's profit-driven medical industry.... and it's on the California ballot this November. PNEWS CONFERENCES provide views with an emphasis on justice, humanitarian positions and TRUTH. To subscribe to PNEWS-L [1500+ subscribers], send request To subscribe to PAIN-L, all aspects of chronic pain; physical & political, HEALTH & health-politics, [850+ subscribers] send: "SUBSCRIBE Nominations are now being accepted for FLAMING ASSHOLISM'S HALL-OF-SHAME: [Vote or nominate your favorite {filter}] http://www..com/ ********************************************************************** "Of course fascists should have free speech. But first cut out their The "REAL" world is full of "real pain," not "PC" bullshit. -HR- ************************************ DON'T LET THE BASTARDS GRIND YOU DOWN!
Wed, 24 Feb 1999 03:00:00 GMT

Andrew Chun #2 / 17	Regulating Healthcare <snip> Quote: > Our baby died after we were pushed out of the hospital too soon by ------ > Healthcare. The coroner's report said our baby died of meningitis or > streptococcus B, and would have lived if we had spent just 6-10 more hours > in the hospital. <...> Quote: > A 27 year-year-old man from Central California was given a heart > transplant, and was discharged from the hospital after only 4 days because > his HMO wouldn't pay for additional hospitalization. Nor would the HMO pay > for the bandages needed to treat the man's infected surgical wound. The > patient died. <..> Quote: > When a 23-year-old diabetic asked her California HMO why it wouldn't > cover the cost of {filter} sugar testing supplies, the company's chief > executive told a newspaper reporter that the company provides all benefits > required by the state. He suggested that the patient "try to get a law > passed requiring the kind of coverage she wants." <...> Quote: > Late last year a three-member arbitration panel awarded over $1 > million to the family of a 34 year-year-old schoolteacher who died of > {filter} cancer. A California HMO was the defendant. Testimony given during > arbitration hearings showed that the HMO tried to "influence or intimidate" > the woman's oncologist and his superior with "argumentative" phone calls. > In the opinion of the panel, "(the) HMO's actions, which were designed and > intended to interfere with an existing doctor/patient relationship, > constitute extreme and outrageous behavior, exceeding all bounds usually > tolerated in a civilized society." > These are just some of the thousands of examples of how the current > managed care system is failing to provide adequate and safe health care. As > healthcare providers charged with the public's trust we need to continue to > gather these stories to counteract the industry's claims that quality of > care is "improving." The Patient Watch program will continue to be an > integral part of our winning strategy for the initiative campaign. Please > encourage everyone who has had a negative experience to submit their > Patient Watch story to us by any of the following methods. sigh I recently took care of a patient who needed a persantine thallium heart scan to evaluate the state of {filter} flow to her heart. I got a call from her HMO insisting that I transfer her to another hospital for the testing (because they get a better price there). The patient wanted to stay but could not afford to pay out-of-pocket as the HMO threatened that they would not pay if she stayed. My father had an inferior wall MI last year and after receiving TPA was moved to another hospital for a catheterization and then another hospital for a six-vessel coronary bypass. If he would have required angioplasty, he would have been moved to yet another hospital. Apparently, each year the HMO shops around for the best prices around town for different procedures. -- Andrew B. Chung http://www.*.com/ ~achung ----------- Physicians on the Web http://www..com/ ~achung/md_web.html ----------- Atlanta Physician Referral Service http://www..com/ ~achung/refer.html ----------- Medical Resources on the Web http://www.*.com/ ~achung/cassie.html
Wed, 24 Feb 1999 03:00:00 GMT

Edward J. Mathe #3 / 17	Regulating Healthcare Quote: > My father had an inferior wall MI last year and after receiving TPA > was moved to another hospital for a catheterization and then > another hospital for a six-vessel coronary bypass. If he would > have required angioplasty, he would have been moved to yet another > hospital. Apparently, each year the HMO shops around for the best > prices around town for different procedures. Our local primary HMO (has 70% of the local market) 5 years ago supplied all of us with little pocket-sezed books that listed all available {filter} and their relative cost (denoted by the number of $$$ after each medication). They recently announced that a new guide will be available soon. This guidebook will list various procedures and their relative cost among the various institutions in our area. For instance, an Angioplasty may be listed $$$ at hospital A and $ at hospital B. Although not required, we are "encouraged" to utilize the less expensive institution/specialist. Who carries the malpractice risk here? -- ================================================================= Edward J. Mathes, RPA-C ! "The greatest derangement of the mind Family Practice ! is to believe in something because
Thu, 25 Feb 1999 03:00:00 GMT

Marcio V. Pinhei #4 / 17	Regulating Healthcare On Sun, 08 Sep 1996 00:08:20 -0700, "Edward J. Mathes" Quote: >> My father had an inferior wall MI last year and after receiving TPA >> was moved to another hospital for a catheterization and then >> another hospital for a six-vessel coronary bypass. If he would >> have required angioplasty, he would have been moved to yet another >> hospital. Apparently, each year the HMO shops around for the best >> prices around town for different procedures. >Our local primary HMO (has 70% of the local market) 5 years ago supplied >all of us with little pocket-sezed books that listed all available {filter} >and their relative cost (denoted by the number of $$$ after each >medication). >They recently announced that a new guide will be available soon. This >guidebook will list various procedures and their relative cost among the >various institutions in our area. For instance, an Angioplasty may be >listed $$$ at hospital A and $ at hospital B. Although not required, >we are "encouraged" to utilize the less expensive >institution/specialist. >Who carries the malpractice risk here? The HMOs with a horde of lawyers and a lot of concocting has managed to have a small printing that in essence says: the doctor! They never say that a patient don't need treatment: "This is up to the doctor"...They say...in our criteria of "medical necessity" we will not pay... Smart, very smart.... Quote: >-- >================================================================= >Edward J. Mathes, RPA-C ! "The greatest derangement of the mind >Family Practice ! is to believe in something because Marcio Baltimore, MD, USA
Thu, 25 Feb 1999 03:00:00 GMT

Leonard Even #5 / 17	Regulating Healthcare Quote: > <snip> > > Our baby died after we were pushed out of the hospital too soon by ------ > > Healthcare. The coroner's report said our baby died of meningitis or > > streptococcus B, and would have lived if we had spent just 6-10 more hours > > in the hospital. > <...> > > A 27 year-year-old man from Central California was given a heart > > transplant, and was discharged from the hospital after only 4 days because > > his HMO wouldn't pay for additional hospitalization. Nor would the HMO pay > > for the bandages needed to treat the man's infected surgical wound. The > > patient died. > <..> > > When a 23-year-old diabetic asked her California HMO why it wouldn't > > cover the cost of {filter} sugar testing supplies, the company's chief > > executive told a newspaper reporter that the company provides all benefits > > required by the state. He suggested that the patient "try to get a law > > passed requiring the kind of coverage she wants." > <...> > > Late last year a three-member arbitration panel awarded over $1 > > million to the family of a 34 year-year-old schoolteacher who died of > > {filter} cancer. A California HMO was the defendant. Testimony given during > > arbitration hearings showed that the HMO tried to "influence or intimidate" > > the woman's oncologist and his superior with "argumentative" phone calls. > > In the opinion of the panel, "(the) HMO's actions, which were designed and > > intended to interfere with an existing doctor/patient relationship, > > constitute extreme and outrageous behavior, exceeding all bounds usually > > tolerated in a civilized society." > > These are just some of the thousands of examples of how the current > > managed care system is failing to provide adequate and safe health care. As > > healthcare providers charged with the public's trust we need to continue to > > gather these stories to counteract the industry's claims that quality of > > care is "improving." The Patient Watch program will continue to be an > > integral part of our winning strategy for the initiative campaign. Please > > encourage everyone who has had a negative experience to submit their > > Patient Watch story to us by any of the following methods. > sigh > I recently took care of a patient who needed a persantine thallium > heart scan to evaluate the state of {filter} flow to her heart. I got > a call from her HMO insisting that I transfer her to another > hospital for the testing (because they get a better price there). > The patient wanted to stay but could not afford to pay out-of-pocket > as the HMO threatened that they would not pay if she stayed. > My father had an inferior wall MI last year and after receiving TPA > was moved to another hospital for a catheterization and then > another hospital for a six-vessel coronary bypass. If he would > have required angioplasty, he would have been moved to yet another > hospital. Apparently, each year the HMO shops around for the best > prices around town for different procedures. > -- > Andrew B. Chung > http://www.*.com/ ~achung > ----------- > Physicians on the Web > http://www..com/ ~achung/md_web.html > ----------- > Atlanta Physician Referral Service > http://www..com/ ~achung/refer.html > ----------- > Medical Resources on the Web > http://www.*.com/ ~achung/cassie.html This is certainly awful. Under the Canadian Helath Insurance system, if I understand it correctly, physicians and hospital representatives negotiate with the Provinces to determine rates. Preumably all facilities then chage the prescribed rates, and this sort of shopping won't happen. Perhaps HMOs and hospital groups should be required to negotiate collectively so that prince would be set by a mechanism which would not affect quality of care. Under the present system, HMOs and even phsycisians have an incentive not to treat. Under the previous fee for service system, physicians and hospitals had an incentive to overtreat. Presumably if we could figure out someway to disassociate the treatment issue from the financial one, we would get better medicine. Now of course everyone will claim this is impossible, but let me point out that I live in a system where it is done regularly. We could organize higher educations so that each course was the subject of financail negotiation. In the middle ages individual professors were in fact paid fees by students to teach courses which the students needed to pass examinations designed by those same professors. Nowadays, students pay tuition to my institution, and I concentrate on doing the best job I can teaching. Unfortunately I am not rewarded much for doing a better job of teaching, although I am rewarded some, because my University is primarily a research oriented institution. Still most faculty try hard to do a workmanlike job of teaching since they don't like to have the reputation of being an awful teacher. At four year liberal arts colleges, faculty arre rewarded for good teaching more, but are also not paid per procedure. If it can work in higher education, it can work in medicine. -- Department of Mathematics, Norwthwestern University Evanston Illinois
Thu, 25 Feb 1999 03:00:00 GMT

Herman Rub #6 / 17	Regulating Healthcare Quote: >> <snip> .................... Quote: >This is certainly awful. Under the Canadian Helath Insurance system, >if I understand it correctly, physicians and hospital representatives >negotiate with the Provinces to determine rates. Preumably all >facilities then chage the prescribed rates, and this sort of shopping >won't happen. This is also "awful". It is totalitarianism at its worst. This is why many local hospitals fold, and require people to travel long distances, at considerable cost of time and money. Quote: >Perhaps HMOs and hospital groups should be required to negotiate >collectively so that prince would be set by a mechanism which would not >affect quality of care. It is fatuous to assume that different doctors and hospitals can give the same quality of care. Nor do we always want the best quality; we do not go to a master mechanic to have the oil changed. Under the present system, HMOs and even Quote: >phsycisians have an incentive not to treat. Under the previous fee for >service system, physicians and hospitals had an incentive to overtreat. >Presumably if we could figure out someway to disassociate the treatment >issue from the financial one, we would get better medicine. This is the Marxist view, stated fairly clearly. Quote: >Now of course everyone will claim this is impossible, but let me point >out that I live in a system where it is done regularly. We could >organize higher educations so that each course was the subject of >financail negotiation. In the middle ages individual professors were in >fact paid fees by students to teach courses which the students needed to >pass examinations designed by those same professors. Nowadays, >students pay tuition to my institution, and I concentrate on doing the >best job I can teaching. Unfortunately I am not rewarded much for doing >a better job of teaching, although I am rewarded some, because my >University is primarily a research oriented institution. Still most >faculty try hard to do a workmanlike job of teaching since they don't >like to have the reputation of being an awful teacher. At four year >liberal arts colleges, faculty arre rewarded for good teaching more, >but are also not paid per procedure. >If it can work in higher education, it can work in medicine. Who says it works in higher education? Or in elementary or secondary education. We get graduate students whose undergraduate transcripts are nothing more than chicken tracks, and whose knowledge and ability are almost totally unknown. I wish more students had those "awful teachers" who tried to get them to understand the subject, rather than to be trained, not educated, in a batch of routine best left to computers. Our universities are flooded with students who have not been presented with concepts, and often not even with the rote, in high school, and woe to a department which tries to maintain standards. -- Herman Rubin, Dept. of Statistics, Purdue Univ., West Lafayette IN47907-1399
Thu, 25 Feb 1999 03:00:00 GMT

George Conkl #7 / 17	Regulating Healthcare Apparently, each year the HMO shops around for the best +prices around town for different procedures. + +-- +Andrew B. Chung This is good, not bad. Should they shop for the highest price?
Thu, 25 Feb 1999 03:00:00 GMT

da.. #8 / 17	Regulating Healthcare Quote: > Apparently, each year the HMO shops around for the best >+prices around town for different procedures. >+Andrew B. Chung > This is good, not bad. > Should they shop for the highest price? It's not so simple. In order to obtain the best benefit for their clients, they should try to find the best medical care. This is often hard to evaluate (i.e. the best heart surgeon in the world might have a high death rate since he or she takes on the toughest cases), but certainly patient satisfaction, board certification, publication in the medical literature, experience in certain procedures and therapy, and other data can be evaluated in addition to the cost of the procedures. In many cases in medicine you get what you pay for. The worst doctors, who don't have many patients, may undercut everybody else just to scrape by, and by your logic they would be hired by HMOs to see patients, rather than better, but perhaps a little more expensive doctors. Ashley Hill
Thu, 25 Feb 1999 03:00:00 GMT

Marcio V. Pinhei #9 / 17	Regulating Healthcare Quote: >> <snip> deleted Quote: >Now of course everyone will claim this is impossible, but let me point >out that I live in a system where it is done regularly. We could >organize higher educations so that each course was the subject of >financail negotiation. In the middle ages individual professors were in >fact paid fees by students to teach courses which the students needed to >pass examinations designed by those same professors. Nowadays, >students pay tuition to my institution, and I concentrate on doing the >best job I can teaching. Unfortunately I am not rewarded much for doing >a better job of teaching, although I am rewarded some, because my >University is primarily a research oriented institution. Still most >faculty try hard to do a workmanlike job of teaching since they don't >like to have the reputation of being an awful teacher. At four year >liberal arts colleges, faculty arre rewarded for good teaching more, >but are also not paid per procedure. >If it can work in higher education, it can work in medicine. >-- >Department of Mathematics, Norwthwestern University >Evanston Illinois I kind of like your thinking Mr. Evens. Stay around. Marcio Baltimore, MD, USA
Fri, 26 Feb 1999 03:00:00 GMT

Marcio V. Pinhei #10 / 17	Regulating Healthcare Quote: > Apparently, each year the HMO shops around for the best >+prices around town for different procedures. >+ >+-- >+Andrew B. Chung > This is good, not bad. > Should they shop for the highest price? The problem as I see it George is that they shop only for the price... Marcio Baltimore, MD, USA
Fri, 26 Feb 1999 03:00:00 GMT

Gconkl #11 / 17	Regulating Healthcare + +> Apparently, each year the HMO shops around for the best +>+prices around town for different procedures. +>+ +>+-- +>+Andrew B. Chung +> +> This is good, not bad. +> +> Should they shop for the highest price? +> +> + The problem as I see it George is that they + shop only for the price... +Marcio +Baltimore, MD, USA Yes, but remember that all the hospitals they use are 'accredited,' and the doctors all have licenses. Generally speaking, all were in business before HMOs, and all the HMO is doing is asking for a price from a group of people who are all in theory equally qualified.
Fri, 26 Feb 1999 03:00:00 GMT

Pete Mitchel #12 / 17	Regulating Healthcare Quote: } } >Presumably if we could figure out someway to disassociate the treatment } >issue from the financial one, we would get better medicine. } } This is the Marxist view, stated fairly clearly. } So what do you say to that, Leonard, you goddam pinko commie? Why don't you just get back to Russia where you belong, hey ;-) -- Pete Mitchell
Fri, 26 Feb 1999 03:00:00 GMT

Gconkl #13 / 17	Regulating Healthcare + +>+ +>+> Apparently, each year the HMO shops around for the best +>+>+prices around town for different procedures. +>+>+ +>+>+-- +>+>+Andrew B. Chung +>+> +>+> This is good, not bad. +>+> +>+> Should they shop for the highest price? +>+> +>+> +>+ The problem as I see it George is that they +>+ shop only for the price... +>+Marcio +>+Baltimore, MD, USA +> +> Yes, but remember that all the hospitals they use are +>'accredited,' and the doctors all have licenses. Generally +>speaking, all were in business before HMOs, and all the HMO is +>doing is asking for a price from a group of people who are all in +>theory equally qualified. +> +> + In theory...Yes, of course they can show a lot of + paper work and diplomas...But, so far, in all these + years, no HMOs ever asked me how I approach + my patients, what I want to accomplish and what + I think is the best treatment. They just want me to + fill up the forms...so that they look good! +Marcio +Baltimore, MD, USA Ok, but since you are a licensed MD, then they are not interfering with you professionally, which is good, is it not?
Fri, 26 Feb 1999 03:00:00 GMT

Marcio V. Pinhei #14 / 17	Regulating Healthcare Quote: >+ >+> Apparently, each year the HMO shops around for the best >+>+prices around town for different procedures. >+>+ >+>+-- >+>+Andrew B. Chung >+> >+> This is good, not bad. >+> >+> Should they shop for the highest price? >+> >+> >+ The problem as I see it George is that they >+ shop only for the price... >+Marcio >+Baltimore, MD, USA > Yes, but remember that all the hospitals they use are >'accredited,' and the doctors all have licenses. Generally >speaking, all were in business before HMOs, and all the HMO is >doing is asking for a price from a group of people who are all in >theory equally qualified. In theory...Yes, of course they can show a lot of paper work and diplomas...But, so far, in all these years, no HMOs ever asked me how I approach my patients, what I want to accomplish and what I think is the best treatment. They just want me to fill up the forms...so that they look good! Marcio Baltimore, MD, USA
Fri, 26 Feb 1999 03:00:00 GMT

Herman Rub #15 / 17	Regulating Healthcare Quote: >+> Apparently, each year the HMO shops around for the best >+>+prices around town for different procedures. >+>+Andrew B. Chung >+> This is good, not bad. >+> Should they shop for the highest price? >+ The problem as I see it George is that they >+ shop only for the price... > Yes, but remember that all the hospitals they use are >'accredited,' and the doctors all have licenses. Generally >speaking, all were in business before HMOs, and all the HMO is >doing is asking for a price from a group of people who are all in >theory equally qualified. One of the reasons government agencies have problems is that they are required to buy from the lowest bidder. Anyone capable of believing that they are even approximately equally qualified should not be allowed to make decisions for others. -- Herman Rubin, Dept. of Statistics, Purdue Univ., West Lafayette IN47907-1399
Fri, 26 Feb 1999 03:00:00 GMT

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