Monday, August 20, 2012

Do No Harm

This article had me fuming since I read it on Saturday. The combination of the horrid heat, the crap coming out of the various campaigns, and this revelation made for a lousy weekend. I didn't appreciate that.

When Bill Buck accidentally cut off the tip of his finger at his Duarte cabinet workshop two years ago, he headed to Huntington Memorial Hospital's emergency room.

He assumed his insurance company would sort out the $12,630 bill from the plastic surgeon, Jeannette Martello.

But Martello wasn't satisfied with the $3,500 insurance reimbursement, so she returned the check and filed a lawsuit against Buck, his wife and his business for the full amount, according to the state attorney general's office. She also began a process to force the sale of Buck's home to collect the money, records show.

Martello's use of aggressive tactics to collect fees from emergency room patients like Buck — including lawsuits, taking out liens on their homes and damaging their credit — prompted an unprecedented court case by state health officials and a judge's order for Martello to cease the practices. ...

The state's managed health care department, which tried more than once in recent years to halt Martello's bill collection practices, said there were at least 10 court cases in which the doctor allegedly violated the law by seeking payments from patients covered by managed care. It's not clear how many patients overall may have been affected, but Los Angeles County Superior Court records list Martello as a plaintiff in more than 50 civil cases since 2010, many of them breach of contract claims.

Under state law, patients like Buck with managed care plans are entitled to have their emergency care covered, experts said. Disputes over payments — for patients with certain plans — are supposed to be resolved between the doctor and the health plan under a 2009 California Supreme Court decision, experts said.

"The Supreme Court was very clear," Lucas said. "If the doctor is unhappy with what they are getting paid by the managed care plan, they need to fight it out with the health plan and leave the patient out of it."
[Emphasis added]

Huntington Memorial Hospital (one of the finest hospitals in Southern California) has terminated its ER contract with Dr. Martello. The California Medical Board (the state's doctors' licensing agency) has filed an accusation, the result of which could cost Dr. Martello her license. And the doctor's response, via her lawyers? Hey, she provided the service, she should get paid. After all, Mr. Buck (and other patients she has tried to gouge) was stable when she got there. He could have elected to have one of the other ER doctors to stitch his finger up.

Yeah, right.

A guy sitting in the ER with a bloody stump of a finger who depends on his hands to do his work can make that kind of decision because he knows a plastic surgeon would just cost too much. That assumes, of course, that someone in the busy ER has pointed out the cost differential to him and that he has calmed down enough to actually hear and understand what is being said.

And that leads to the broader issue of health care in the country, something being "debated" this election cycle. Yes, the US has a fine, even excellent cadre of medical providers. The problem is that only a few can freaking afford to access it. That was the whole point of the ACA and the Medicare cost reductions which President Obama developed. Is it a perfect solution? Hell, no! But it's a welcome start on the road to reining in the cost of treatment so the rest of us can get it. Managed care need not be a dirty phrase. It does not mean death panels. What it means is that those of us who are not filthy rich (and I use the adjective intentionally) can finally get that treatment early on, before the treatment is extensive, and can get that treatment in awful emergencies like Mr. Buck's.

Yes, it does mean that health care providers won't make the gazillions to which they fervently believe they are entitled. They'll still do all right. And that brings me to the cherry on this foetid sundae:

Martello, a 1988 UCLA School of Medicine graduate, also has published a plastic surgery magazine and offered a line of skin care products. She attended law school at UC Berkeley, though she is not licensed to practice law in California, according to the State Bar of California. [Emphasis added]

Orly Taitz, anyone?

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Blogger ifthethunderdontgetya™³²®© said...

People. The concept is sometimes better that the reality.

4:44 PM  

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