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Urge
For love and for money
Since I was a teenager I have let money rule my life. Now could it ruin my prospects for love?
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[10/14/99]

Irish coffee cure
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[10/13/99]

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Ex-model/novelist Brad Gooch's "Finding the Boyfriend Within" reaches a new low in the gay self-help genre.
By Daniel Reitz
[10/12/99]

Political football
The right to sue may be tossed around for the next year.
By David McGuire
[10/11/99]

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Special delivery
A mysterious letter smolders in the lingerie drawer.
By Tracy Quan
[10/11/99]

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In these, Elizabeth is in a hospital bed, with tubes and machines connected to so many places on her 9-pound-11-ounce body that the weight of all the equipment looks like it could crush her frail chest and limbs. Stuck loose into the album is a newspaper clipping a paragraph or two long, celebrating Elizabeth's short life and announcing her death on Oct. 8, 1995.

Four years later, Glenn Wooldridge points to a stack of documents -- medical records, test results, doctors' referrals -- several inches thick, when he talks about what happened to her. Officially, she died of complications from cystic fibrosis, a devastating genetic disease currently affecting 30,000 adults and children in the United States. But her family, who lives in Rodeo, Calif., blames her death on their health maintenance organization's medical group. The Wooldridges say that the medical group should have authorized a "sweat" test that could have detected the disease when it was first suspected.

The sweat test was requested by her physician to rule out cystic fibrosis, but was repeatedly turned down by her HMO's medical group -- until Elizabeth's lungs collapsed a month before she died. "It was only a $125 test," says Glenn Wooldridge, an iron worker who looks older than his 29 years. "If she had gotten the test would she still be alive? She would have at least had a chance, they could have done something about the weight gain, they could have put her on certain medications ..."

It is still not clear that Elizabeth's life could have been saved if she had had the sweat test earlier. But Dr. Nancy Lewis, a specialist in cystic fibrosis and Elizabeth's pulmonologist at the time, believes that an earlier diagnosis might have saved her life. "You have to realize that [in the time it took for her to get the test authorized], she went from a baby at home, to a baby in an emergency room, to being admitted to the hospital, transferred to the intensive care unit and going on life support," she says. "I think if this baby had been diagnosed, she would have been managed differently, she would have been kept off the ventilator with a diagnosis of cystic fibrosis. When babies have cystic fibrosis, the ventilator pops holes in their lungs, and they can't heal the holes in their lungs because the ventilator keeps the holes going. In my experience, it's always a grim outcome. I don't know if [Elizabeth] would have survived, but I would have expected her to." And the Wooldridges want some type of recourse for what they believe were the penny-pinching policies that valued money over their daughter's health. But under federal law Glenn Wooldridge's ability to sue his insurance company is limited because he is a private employee. He can't sue for anything other than the cost of the care denied, which in this case is the cost of the test. Making things even more complicated for the Wooldridges is the fact that the medical group is no longer in business and the HMO has merged with another company.

"Anybody who wants to sue an HMO will tell you that it's not about the money, it's about proper care," Wooldridge says.

Horror stories like the Wooldridges' are well-known by now, and seem so horrendous that they almost sound the same, only with different names and different denied treatment options. There is the story of a child who had a brain tumor and was denied access to a specialist; the one about the person whose HMO only authorizes one colostomy bag per week, requiring her to clean it out after each use; and the one about the woman who needed a liver transplant and the HMO wouldn't pay for it.

"Every day doctors see evidence of delays or alterations in the health plan that they have for their patients; they are frustrated; they are exasperated with it," says Dr. Alan Baum, president of the Texas Medical Association.

It's no secret that spending on medical services is under much tighter supervision than ever before. With the old fee-for-service system, one health policy expert says, the problem was over-treatment. The problem now with HMOs is undertreatment, she says, and either can kill you. Inevitably, there are going to be cases where cost-cutting measures have unfortunate and even tragic consequences. But these stories are generally not representative of the everyday care provided by HMOs.

"It happens every day, but generally it's in subtle ways. Typically, it's not that someone has terrific chest pain and you think that this person needs an arteriogram and it's denied right on the face of it," says Baum. "It's more like well, maybe you need a consultant, or to try a change in medication, but that's expensive, so how about this other medication instead?"

The right to sue an HMO for emotional distress and punitive damages has suddenly become one of the hottest political and legal issues in the United States, at the state, federal and judicial levels. Last week, the House passed legislation -- the so-called Patients' Bill of Rights -- that among other things would give consumers that right. A similar bill passed by the Senate in July does not have the liability provision. The issue is now in the hands of a House-Senate conference, where the provision awaits its fate. Either way, both sides say, the state of health care in America will change drastically.

Proponents of HMO liability say it's the crux of any health-care reform, because it will actually change the behavior of managed-care plans. Out of fear, these people argue, HMOs will stop thinking about saving a few bucks for a treatment, because they could later be faced with millions in the form of a lawsuit.

"I think it's going to give patients the leverage they need to get more medically necessary treatment from HMOs that would otherwise be denied to save money," says Jamie Court, director of Consumers for Quality Care, a patients' rights advocacy group. "The point of this is to give patients a stick to use when they have to, but hopefully they won't have to. But the threat of it will make them be more reasonable with them and their doctors."

But will it?

Next page | Will more people end up uninsured?