Thank you to the Daily Kos community for your response and suggestions to the diary I posted on Sunday. I promised an update when I had something to report. If you missed the diary, it's too long and involved a story for me to recap it here, so please visit the diary itself.
If you just do NOT have time and you missed the diary, the very very short summary is that I was slated to visit Congressman Nick Lampson's (TX-22) office this past Monday to enlist their assistance in helping my Grandmother deal with her Veteran-supplied HMO. I made that visit, and I have a lot to report.
Follow me over the fold.
The whole point of the visit to the Congressman's office was to enlist the assistance of his office in trying to get my Grandmother's HMO (furnished as a military veteran's benefit to my Grandfather, a decorated war hero) to STOP almost killing her. Here is the letter I wrote with personally identifying information removed:
The Honorable Congressman Nick Lampson
436 Cannon House Office Building
Washington, DC 20515
Dear Congressman Lampson,
I am writing to you on behalf of my Grandmother, GrandmaRF. She is 88 years old, widow to a decorated WWII and Korean combat veteran, and a constituent in your district. Most importantly, she and my family are struggling within the healthcare system that she receives as a "benefit" of my Grandfather’s distinguished service to our country.
I would like to first say that I sincerely hope you are recovering from your recent surgery. I have read some of the news coverage of how and why you were scheduled for quadruple-bypass on a preventative basis. You are fortunate that you have doctors who were looking after the overall picture of your health and stayed focused on your well-being to the extent that they determined surgery in the near-term could prevent a life-threatening incident in the future.
My Grandmother has not been so lucky. As a retired military spouse, she receives her benefits from the Uniformed Services Family Health Plan (USFHP). This is what was made available to her, and we are certainly grateful that she has any health coverage at all. USFHP is an HMO. As such, she is assigned a general physician whom she visits in the same way you would visit a general practitioner. For specific health concerns, she is referred to a physician specialist. In your case, I would assume you have a cardiologist. In the case of my Grandmother, she has a pulmonologist. Her underlying condition, diagnosed well in advance of the current issue we are having, is pulmonary hypertension. This condition was serious enough to necessitate her being placed on 24/7 oxygen. In other words, it was serious and the pulmonologist was the central point of coordination and responsibility for the myriad of other concerns that arose.
Rather than drag you through her entire medical history and timeline of missteps and indifference and mistreatment, I’ll ask you to consider a scenario. This is particularly apt, I think, in light of your recent experience within the healthcare system. Imagine that you knew something was wrong with you but you couldn’t get anyone who would authorize the tests necessary to pinpoint the cause of your malaise, let alone take proactive steps to diagnose any underlying condition. So to get healthcare you deemed necessary, you had to fight for it. You had to see first one doctor, then another. You didn’t get to choose which doctor you saw and even though you were by far less-than-comfortable with the specialist they assigned to you (after you fought for it), you had to keep that doctor and make do as best as you could.
Now imagine that there was a medication that everyone else with your diagnosis was placed on to prevent future crises. You don’t know about this medication, but the doctor should. Yet the doctor doesn’t put you on the medication, and you only learn that you should have been on it after a crisis. Had the medication only been prescribed, it could have been avoided. Yet it wasn’t. And you were rushed to the hospital in the middle of the night for emergency surgery to save your life. You survive that surgery – you were lucky. And now all you want to do is take the steps that help you recuperate so that you can return to your home. You graciously don’t harbor ill-will towards the HMO or the primary specialist – you just want to get through your rehabilitation and get out of medical facilities.
Yet every time you turn around, something gets in your way. Your insurance company fights you. It refuses to grant authorization to send you to a rehabilitation center that is integral to your recovery. Even though you can’t walk on your own or sit up on your own or go to the bathroom on your own, it is recommended that you simply be sent home. You think you’re being sent home to die – because you can’t care for yourself and your doctor no longer seems interested in caring for you. Over a better than three-month period you have to fight through a series of issues. At every turn, it seems that your physician doesn’t want to run tests or expend any resources on your care. You are dejected, and you are becoming emotionally deflated. Everyone seems to simply want to send you somewhere to die, and you are succumbing to a depression that impedes your ability to recover.
Now let me break away from this scenario. This is, hopefully, not the scenario with which you dealt. You seem to have had doctors available in a cooperative system that was managing not to a bottom line cost, but your overall health and well-being. Yet the difference between your experience and my Grandmother’s experience is stark. At every turn, we, the members of her family, have had to fight for her care. It has gotten so bad that a kind staffer at one of the facilities pulled a family member aside and urged us to contact you. This person also indicated that the family had to "push back" on the HMO – stand their ground – fight for my Grandmother’s care. I ask you: WHY does she, a human being, have to fight for care to which she is entitled? Why is it a choice between the cost of a test and quality of her health?
My family members and I have, quite frequently over the last three months, commented that if my Grandmother were alone in this world with no one to fight for her, she would have been dead months ago. That is what I can say about her experience – that the family has had to fight to ensure the system didn’t kill her. That’s a sad commentary, Congressman. It’s shameful. She is a military wife and my Grandfather died with at least some peace of mind that his wife would be cared for as she aged. I’m sure he’s spinning in his grave at Arlington Cemetery with what has transpired.
I would like to ask you to intervene on behalf of my Grandmother. I would like you to contact USFHP and help her to have her complaints and concerns addressed. I want her to be treated like a person, and a person deserving of every opportunity to get better and go home. The fact that she is 88 should not preclude compassionate and competent care. I have it on good authority that Congressional inquiries are taken seriously when government-contracted healthcare is involved. It’s a shame that this is what is required, but it seems it is. And so on behalf of your constituent, I ask for your advocacy that she be treated with the same level of respect and care that you received.
I or my mother can provide you with relevant contact information. I am attaching copies of two letters – one sent directly to USFHP with specific complaints about the care my Grandmother received and another sent to the Texas Medical Board’s Investigation Department. I can be contacted via email at (email address) or via phone at xxx-xxx-xxxx. My mother, MommyRF, can be reached via email at (email address) or via phone at xxx-xxx-xxxx. In either case, we will get you whatever information you require to intervene.
My best to you and your family, and thank you in advance for you attention to this matter.
Respectfully,
RenaRF
Now - before I briefly talk about what the last five days have seen, let me say that I could not have written this letter without the input and assistance of many thoughtful comments and suggestions in the thread of the diary linked in the intro. Many of you provided insight, specific suggestions based on similar experiences, and even points of contact at Lampson's office - this was invaluable, and I thank you. Deeply.
On Monday morning I left my house early and went down to Capitol Hill. I had two copies of the above letter as well as two copies of the letter's to the Medical Board and USFHP - I was visiting two offices. My first destination was the Congressman's office. I went through security at the Cannon House Office Building, went up to the 4th floor, and walked along to his office. Once inside, I was told that the Congressman himself wasn't in town (naturally). The young male staffer behind the desk asked if he could help, and I briefly explained the reason for my visit and made it abundantly clear that I would be following this up even if it meant I had to come back down there another day and sit outside the office until someone saw me. I wasn't nasty abut it - Lampson's a friendly - but I wanted them to know with clarity that I was going to get this addressed - it could be the easy way or the hard way.
The staffer was VERY helpful, took my copies of the letters, and gave me a card for the Congressman's legislative assistant who handled healthcare issues. The staff themselves had a full day on Monday (first day back after the break) and he suggested I call back Tuesday if the loop had not been closed.
I thanked him and headed over to the Rayburn House Office Building to the office of Congressman Bob Filner (CA-01), Chairman of the Committee on Veteran's Affairs. I talked again to a very nice staffer there - I wasn't asking them to do anything for me, but I indicated that I had formally requessted Congressman Lampson's intervention and that I wanted teh Committee to have a copy of the letters for their information as they moved forward into issues related to Veteran's health affiars. The staffer there was also VERY nice and specifically marked the letters for distribution to the apporpriate subcommittee.
And then I left. I went on about my work day. Tuesday morning, bright and early, I called Lampson's office. I got the same staffer who took the letter and asked for the legislative assistant whom he said would handle such requests. The staffer was in meetings, but I was absolutely assured that I would get a phone call that afternoon.
So I went on about my Tuesday. At about 2pm, on my way up to Baltimore, I got a phone call from Lampson's office - it was a third person, a name I didn't recognize. She was incredibly compassionate. She related to me a story about her Grandmother - it was related in that she could totally understand the frustration of being a family member caring for an elderly relative in an overwhelmingly impersonal system. She told me that this was a casework issue, and that she was going to fax the information down to the Houston office. She assured me she would call me back with the name and phone number of the caseworker as well as the process once she had sent the information and identified the appopriate individual. I thanked her and hung up.
One hour later, she called again (she got my voicemail - I was on a conference call). In the message she told me the name of the Houston caseworker, the process, and gave me all of the contact information. She further indicated that she would call MommyRF and communicate the same information (I had provided her contact information in the cover letter). She did that. Before COB on Tuesday a caseworker from the Houston office was on the phone to my mother.
By Wednesday, the Houston office had faxed over a privacy release form that they required to provide to DoD so that they could get GrandmaRF's history and begin the process. By Wednesday night, my Houston family had faxed that release back. By Thursday morning the Congressman's office had called USFHP and informed them that they would be conducting an official inquiry on behalf of GrandmaRF. By today, the Congressman's caseworker was back on the phone to MommyRF getting additional information and getting further engaged. For once, with meaning: Mission accomplished.
An interesting sidenote - for the FIRST TIME in SIX MONTHS suddenly the HMO got proactive and CALLED GRANDMARF (that has NEVER happened. Never.) and indicated that they were going to "go outside of their regular procedures" to refer her to a very specific type of specialist. That seems like a small thing - but let me tell you - it took a personal visit to a Congressman and that Congressman's willingness (or at least his staff's willingness) to get directly involved to accomplish something as simple as some simple, human, proactive care.
My family continues to work with the Congressman's office - while GrandmaRF's immediate needs have been mitigated, the pattern of poor care continues to bother us. My mother and the Congressional caseworker have agreed that they are going to continue to address the systemic issues - because that's what got us here in the first place.
Interesting sidenote: The Houston branch of my family have always been Republicans. Not any more - at least not where Nick Lampson is concerned.
Finally, if you're so inclined, you can thank Congressman Lampson. That link will take you to a generic "Write your representative" page - just select him from the drop down box and continue on. Thank him for his office's willingness to advocate for an elderly military widow lost in the abyssmal outsourced military HMO system. Thank him for his office's willingness to get directly engaged with USFHP. And wish him a speedy recovery and unfailing good health going forward.
Thank you all - you are a gem of a community. I know we have our quarrels and kerfuffles and warts, but this wouldn't have happened with you, and my family is the beneficiary.