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I spent most of today with my best friend trying to find a place to bury her mother.  She wanted to do it with Inglewood Cemetery but they are so booked they could not do it for a week and a half.  Their attitude was she should have faced the truth and done it sooner.  People are dying so fast in the hood that funerals are a booming business.

Her 60 year old mother died a long slow painful death from January of last year til Thursday night because she had excellent insurance and no basic medical knowledge.

We will call her Belle because she was beautiful with equisite eyes.  She was witty and she had a life.  She is the mother of five children and her oldest son was killed in a drive by shooting and her hair turned white overnight.  Her youngest daughter is my best friend and I tutor her 13 year old son.  Her daughter works for the Department of Water and Power in
Los Angeles in a good union making good money, a homeowner, and a responsible community member.  Her daughter has kept her mother in good insurance policies ie: supplemental medical etc.  She was recently disability retired from the US post office service.

The whole family is on some form of PPO which they all understand is more expensive but gives them choices they are willing to pay for.  Belle had a heart condition for over ten years but was stable and responsive to medication.  The family sees doctors in a medical group.  Bells's cardiologist is in the group and she saw him on a regular basis.

In January, Belle sees the ENT specialist of the group for acid reflux.  She is in good and stable health at the time.  Because more and more people in LA are loosing their jobs and thus their health insurance and cannot afford expensive cobra and/or expensive co pays in their regular insurance, these groups are seeing substantial reduction in their incomes.

Their defense is to seek to do more and more procedures that are more and more invasive because they pay more money.  So instead of just giving Belle some more efficient acid reflux prescription pills which is their intention,  they tell her we want to do an endoscopy and look down  and see what is actually going on.  At this time, there are no breathing problems and no bleeding problems nothing really that serious to not try the pills first.

The doctors do so many of these endoscopies that they consider them rather routine and no big deal.  They do it locally in a semisurgical room with a
nurse anthestist who uses minimal respiratory assistance machines and with not the most sophisticated of response levels.  They feel the twilight sleep is easier on the patient and easier on them and it adds to the billing.

Make no mistake this is in fact a form of elective surgery which the patient has no real idea of the inherent risks.  But both her daughters called and asked should they drive her and should they be with her and both were told it was not necessary and no big deal.  Belle's ingroup cardiologist was never consulted or even advice the procedure was being scheduled.  He has admitted it would have never advised the procedure and with her heart conditiion she required a defibulator to be present which was not the case.

Sometime during the procedure, Belle stopped breathing and no one is really sure for how long because the machine stopped working and the anesthetist did not notice because when the machine stopped working there was no automatic warning bells whistles or lights.  You would have to be paying attention to your patient which is soooo 1980s in today's billing madness.

So Belle has been in a coma ever since.  She has been moved to three different facilities so far.  She went into the hospital Wednesday because she had a severe lung infection.  Both her daughters visit regularly and they keep informed of her care like she bit her lip or bedsores etc.  But no one told them she had a lung infection until she is majorly hospitalized again.  No one told the daughter Belle had a lung infection because they were not treating it.

I spent 4 hours with Belle and her daughter Thursday.  I listen to the five doctors on their rounds.  She now needs dialysis, a blood transfusion, etc.  She is still breathing on her own but needs intensive respiratory therapy with medication to reduce the swelling in her lungs.

I listen to the social worker go through her litany.  And everybody wants the daughter to sign the DNR which up to now she has refused to do.

I am here for an outside medical analysis for the daughter because she wisely now trusts no one.  I am also very spiritual about the process of death at this time.  The daughter and I have lunch and dinner together.

I tell Belle that I love her daughter and she can be very proud of the job she has done raising her and she has a grandson she can be proud of.  I tell her daughter her mother is very tired and is sick of all the poking and proding and she is staying because her daughter wants her to.  I tell the daughter she can tell Belle she loves her dearly, will miss her much but she is okay and will be all right if Belle wants to go.  When the daughter says this to Belle her heart instantly stops and the daughter is okay with it.

This is now a law suit but with caps etc. there is no real money in it.  But this was a long slow agonizing death for no reason but a billing.

When medicare came in the AMA opposed it but at the same time they were working on how to use it.  My first husband began medical school in 1966 and medicare began in 1968, and he did his first practice management seminar in 1969 prior to even graduating in 1970.  My first husband got into medical school with Cs and Ds because his father was roommates with the president of the medical school he attended.  He flunked biochem five times and was allowed to take it til he passed.  He was in the bottom of his class.  Lucky for patients he died of renal failure from being alcoholic before he did too much practice.  Everyone should be aware that all medical care is labeled PRACTICE.

What medicare did is introduce dipstick medicine.  The doctors found they could bill for every action and so more and more actions were developed.  The mantra being they had to protect themselves from mal practice.  It has been my personal experience that that is plain and simple bullshit.

In 1968, a routine urine analysis was sent to a lab and cost $28 which was fully paid by medicare.  Almost over night there was the invention of dip stick testing of urine which allowed all doctors offices to bill for urine analysis for dipping their sticks.

A lot of medical "progress" was waiting in the wings because there were no patients to try it on.  High quality surgical heart care was available but it was not perfected.  One of my nursing instructors was on the surgical team of a major hollywood star who died at 43 on the table because the heart surgeon accidentally servered his aorta.  Heart surgery was known to be both dangerous and expensive.  The same with eye surgery for cataracts etc. that led to all the lazer retinal repairs today.  But notice all these doctors wear their glasses because they do not know what long term results of some of these surgeries are.  Where to get the patients to practice on?

Well medicare provided them.  Most were too old and not educated enough and not cynical enough to realize that doctors would proscribe something at the drop of a hat to make money.  Not all of them but by far too many of them.

One hospital in LA got in so much trouble that USC servered their relations with them.  The hospital took a huge hit until they came up with the idea of a definitive observation unit.  How to fill it.  They went out to convalescent hospitals and rounded up those without family or funds and put them on respirators, etc. the whole works until they died.  Presto, in six weeks after the DOU opened the hospital was in the black.

All of the really horrible and major medical practice I have seen never went to court and for the most part never saw the light of day.  That is because everyone with responsibility covered it up and those who might potentially tell the truth were threatened with their licesnses and black balling etc.  For instance the heparin dosage delivery labeling has been a problem for some time and was known and had cost some infant lives before the Dennis Quaid twins.  The Quaids said they sued because they found out it was known and nothing was done until they high profiled it.  This is typical of US medical practice.

So doctors got tons of experience from medicare they never would have had to serve the very, very wealthy much more safely.  Recently in LA, three doctors were arrested for medicare fraud to the tune of 150 million dollars.  They were recruiting the poor for unnecessary surgies like carpal tunnel syndrome etc to bill medicare for.  The moral hazard everyone talks about is not patient abuse---all the US together of patient abuse would not equal just those three doctors alone.

Patients are caught between the insurance companies who know how many doctors practice medicine and the patients who need care.  We pay twice as much for everything as the rest of the world and we can no longer afford it.  We need doctors and medical care people who want to be healers.  We can no longer afford a medical system based on wealth, power, and prestige.

That is what we are really fighting about.  The same thing as the banksters.  Accountablility as to how these professions are practiced.

It is the simple:  when do the needes of the many out weigh the needs of the few?  The few will always always answer never but they will do it in beautiful patriotic terms.

Meanwhile your death is expected and it will be planned well to make it as profitable as possible and when it is not--the plug will be pulled or maybe never even placed in the socket.  And the corps will collect their dead peasant insurance that they are swaping around the world.

I have done the best I can on this diary.  I remain closed head blunt brain injury and I am not in the mood for the grammar police.

Originally posted to yoduuuh do or do not on Sat Oct 31, 2009 at 10:58 PM PDT.

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Comment Preferences

  •  This is a Superb Diary (6+ / 0-)

    I have seen so much of what you write about. So very much. The cuts to Medicare for these negligent and corrupt behaviors are the only thing that can bring costs down. It's in no one's interest to do this, however. Everyone should have a designated friend to act as advocate, preventing procedures and medications. This is not the same person as designated in the Medical Directive.

    Highly Recommended.

  •  Living Will? (3+ / 0-)

    Tragic story.  

    If I read the diary correctly it indicates that the victim in this very unfortunate circumstance was in a comma from January of last year (2008) until October (2009) or 22 months.  That is a terribly long time to be in a coma.  Did the victim have a living will?  If not, would she have wanted her family to continue indefinitely with life extending procedures?

    As to the issue of health care providers doing unnecessary and risky procedures for Medicare patients ... that obviously happens to varying degrees and in this case to an egregious degree.  Medicare does not have any type of review process for determining what is or is not medically necessary that I am aware of.  Makes the system susceptible to abuse by those that we trust with our lives.  

    •  Thanks for this. I can see I was unclear. (2+ / 0-)
      Recommended by:
      Pluto, Dirtandiron

      It was January of 09 this happened.  And the daughter wanted to see if time the mother would recover.  Her view was that if it was her mother's time she would go since people with a lot of money and pull can not be resuscitated and stabilized.  She felt that this was done to her mother and could be fixed.

      Under these circumstances from the get go, the medical group had been paying for her care.  Which is why I believe the lung infection was untreated from the time they knew of it.  This is trying to bury the evidence and make the eventual settlement cheaper.

      The whole point of the suit was perpetual care for her mother.  Also she was going to have a room added on and prepared for her which she felt was cheaper and safer than convalescent hospitals.  EEGs showed some brain activity and they could not pronounce her
      brain dead.

  •  SO IMPORTANT what you have written (4+ / 0-)

    Written well and SO descriptive of many of the worst problems that plague our medical system. I've experienced some of them in my own family. Until it happens to you it is almost impossible to imagine. You've managed to describe it as a medical professional would see it and as a family sees it.

    Highest recommendation for your diary.

    Deepest sorrow that this is where the medical system is today.

  •  2 examples of "the cure being the cause" here... (4+ / 0-)

    Two examples in the past 20 years of "the (so-called) cure being the cause" of life-threatening problems here...

    FIRST story: I have been taking allergy drugs all my life...I have pretty bad, year-round allergies...but nothing that can't be fairly well alleviated with maintenance med's.

    For about 3 or 4 years I took the prescription drug, Seldane, for my allergies. One day, I developed a minor skin infection on my leg, and went to a dermatologist to check it out. He prescribed erythromycin. I took it for a few days and one evening I started feeling as if I was going to pass out. This persisted for another day or two, and I went right to my doctor.

    Ended up doing a series of tests (I was otherwise in good health, and only in my early 30's at the time) at a cardiologist, to the tune of $2,000 in bills. (During these few days, my prescription for erythromicin was used up and the minor infection went away.) The heart-related testing showed nothing substantive of any sort. I was feeling better around the time my heart-testing was concluded, and that was that.

    A few months later I found out they had formally announced in the news that SELDANE and ERYTHROMICIN, when taken together, could be induce sudden, fatal heart attacks.

    SECOND story ("my trip to the periodontist"): Had my upper, left-rear molar tooth removed ("tooth #14") and was being setup for a dental implant by a periodontist (to whom I was referred by my regular dentist). The root of this tooth abuts the sinus.

    In the process of prepping the jawbone for the implant, the periodontist did a modest bone graft--a very common procedure for this type of situation, I was told. I was told to let the bone graft heal, and to return for the implant procedure a couple of weeks later. I was prescribed a standard antibiotic and about a three-day's supply of Percosets.

    I returned ahead of schedule to the periodontist, about a week later. The bone graft wasn't healing properly and I was in great pain. The periodontist tried to tell me that there was nothing wrong with his work, and it was due to the fact that I was a cigarette smoker, which at the time I thought was fairly incredulous; because I was always complimented by my regular dentist for how quickly my gums healed after anything had been done in the past, to the point where my healing was noticeably better than most of her patients. (I'd had a fair amount of dental work done over the years up until that point in my life.)

    (I had been on antibiotics this entire time, as prescribed by the periodontist.) The periodontist did prescribe Vicodin, however. I returned to the periodontist another 10 days later, and still no improvement. By this time, fluid was seeping into my mouth from the still-unhealed bone graft surgery. Exacerbating the problem, I was doing a lot of business travelling at the time, and the flights were causing bad pain from this to be even worse than horrendous.

    On Halloween of 2005, I ended up in the emergency room of my local hospital for this pain, and the diagnosis was sinusitis. It was SEVERE pain. (They did an MRI at the hospital, too. My health insurance, at the time, covered it all.) I was prescribed much stronger doses of antibiotics and Oxycontin.

    A week later, still no improvement. (More Oxycontin and more of the stronger antibiotics.) My regular doctor adviserd me to go to an ear/nose/throat specialist; and luckily, one of the leading ENT's in the country was the person to whom I was referred.

    I was told by the ENT's office to bring my MRI pics from the hospital with me to the appointment, so I did. The top ENT dude did a fairly thorough exam of the situation and took a very long look at the x-rays from the hospital visit and said they ran the x-rays in such a manner whereby they failed to notice that there was a PUNCTURE of MY SINUS that occurred during the periodontal surgery many weeks before. By this point, I had been taking pretty strong doses of Oxcontin, along with heavy doses of antibiotics for at least a few weeks (funny, when there's severe pain, one can still function with that much of that strong a drug in you...at least that was the case for me at the time). During the course of this ENT visit--again, one of the top ENT practices in Fairfield County, CT--one of the specialist's associates came into the consultation and told me she was a family friend of the periodontist since childhood.

    I never received a bill for the ENT visit.

    The ENT never made a claim with my insurance company.

    About a  year later, my regular dentist told me that my case had caused quite a stir in the dental community in Fairfield Cty, CT and Westchester Cty, NY. And, she also told me that over 30% of these procedures were causing some form of PUNCTURE OF THE SINUS of the patients upon whom it was performed.

    If it wasn't for the fact that I insisted on heavy doses of antibiotics (many years earlier, a friend had almost died from encephalitis, and that may be caused by any infection on or near the brain, as I learned at the time), I could've developed DEADLY complications from the entire matter.

    I never sued anyone over this, but I was told it was a clearcut case of malpractice.

    (Trust me, I know this is "more than you needed to know," but walking around for 5 or 6 weeks with your sinus dripping into your mouth from a hole in your gum is one of the most disgusting things I've ever had to endure in my life.)

    "THE CURE" IS OFTEN "THE CAUSE."

    "I always thought if you worked hard enough and tried hard enough, things would work out. I was wrong." --Katharine Graham

    by bobswern on Sun Nov 01, 2009 at 02:00:29 AM PST

    •  You were very lucky. And you had a strong body. (5+ / 0-)

      Someone with a compromised body would have had almost direct access to a brain infection and died of this.  I know of cases where this happens.

      The big reason in my book for not wanting electronic records and not wanting single payer is that for the first time we would have a unified way of tracking doctor's outcomes, as well as, hospitals.

      As the AMA doctor in Florida who sent out the pictures of Obama as a witch doctor, it was obvious to me that this 36 year old surgeon wanted to practice without consequences and the consequences were holding him back from doing so.

      It is also interesting to me that like your diaries
      no one wants to read this kind of stuff because they do not want to contemplate what they feel helpless about.

      The whole idea that the public could "shop" for the best medical results is ludicrous.  For one they don't have access to the real stats.  For two you really have to know something to understand your choices.  Three, in a medical crisis there is no time for this if it were possible.

  •  I learned the hard way not to trust (3+ / 0-)
    Recommended by:
    Pluto, yoduuuh do or do not, bobswern

    "medical professionals".  They are "practicing" medicine, which implies they haven't really gotten it right yet.  I became a walking medical encyclopedia after they damn near killed my Mother.  I researched every drug they prescribed her, fired doctors on a regular basis and brought her back from the brink.  Sadly, she had to have a gallbladder surgery and a week later she started bleeding internally and nobody noticed until shift change in the ICU, by that time her BP bottomed out and destroyed her kidneys...It took a month for her to die.  I truly hate them.

    ~War is Peace~Freedom is Slavery~Ignorance is Strength~ George Orwell "1984"

    by Kristina40 on Sun Nov 01, 2009 at 06:55:31 AM PST

    •  I have been where you are and I know (2+ / 0-)
      Recommended by:
      Pluto, Kristina40

      how bad that hurts.  My late husband is the only one I know to have survived such an ordeal.  He had a toxic reaction to a beta blocker.  When he presented in the ER, he was giving a classic presentation to appendicitis but because he has a heart condition, they never even palpated him.

      The doctor wanted to do an immediate quadruple by pass and was appalled when I refused.  At the time, we were visiting in Texas.  I told him his diagnosis matched nothing I had been told at Cedars Sinai in LA.

      I tried to fire him on the spot and was told I could not.  Only his primary physician could.  So they sedated him for the entire 4th of July holiday because his primary physician could not be reached.  At the end of that time his stomach had expanded to three times its normal size and he was turning green.

      The only surgery he had was for a ruptured appendix and removal of necrotic tissue in the perineum from that.

      He was hooked up to nine machines for 22 days in the ICU and survived.  The only machine not having bells and whistles was the NG tube suctioning the shit out of his abdominal cavity.  That is because it is the simpliest.  I found it repeatedly stopped up while the staff dithered.  Knowing how it works, I never said anything but I just looked.  At one time they threw me out of the ICU for looking.

      It is too sad to LOL.  My relatives all take the position if I was so smart why wasn't I a doctor until they are hospitalized and then they beg me to come and stand guard over them.

  •  Tort Reform is Not Needed. (2+ / 0-)
    Recommended by:
    yoduuuh do or do not, bobswern

    This should be in the title.  In about 2005 several states were pushing to cap or eliminate awards for malpractice.  

    The state of North Carolina and about the same time, the Government Accounting Office did a study of the cost burden, malpractice settlements add to the cost of medical care.

    Both studies ended up in the range of .5%, that's right, one half of one percent of overall costs.

    Another argument often used is that patients will sue over any small event. The courts simply will not let frivolous lawsuits clog up the system.  Often patients are sent to binding arbitration or simply tossed out of the system before they are given a chance to be heard.

    Sometimes the ability to bring a lawsuit is the only process between patients and malpractice.

    One cost that is high is the premium doctors pay for malpractice insurance coverage.  This issue needs to be addressed.  Once again insurance companies are charging what they can, whether they put doctors out of business or not.

    But those crying out for tort reform want to limit a patient's right to sue.

    I am so sorry for this lady and her family.  This should never have happened.

    "Never, desist till we ... extinguish this bloody traffic, of which our posterity, will scarce believe that it suffered a disgrace and dishonor to this country.

    by Regina in a Sears Kit House on Sun Nov 01, 2009 at 09:48:07 AM PST

    •  You should write a diary about your house. (1+ / 0-)
      Recommended by:
      Regina in a Sears Kit House

      I love them and if you have send me the link.  And thank you for your understanding.

      •  Hi, thank you. (1+ / 0-)
        Recommended by:
        yoduuuh do or do not

        There seems to be a small group here that either has or loves Sears Kit Houses in general.  gchaucer2 has also said maybe a GUS diary with Sears Kit Houses too.

        I need to get an album together, the photos in different seasons and years are all over the place.  I like your idea.

        I really think most of us do not understand what the "tort reform" advocates are saying.  So I add it to comments where ever it seems appropriate.

        It has two parts: 1) patients' right to sue; 1) malpractice insurance premiums assessed to doctors.  Certain specialties, esp. OB/GYN, pay very high premiums.

        "Never, desist till we ... extinguish this bloody traffic, of which our posterity, will scarce believe that it suffered a disgrace and dishonor to this country.

        by Regina in a Sears Kit House on Mon Nov 02, 2009 at 10:57:46 AM PST

        [ Parent ]

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