Saturday Dec 28th 1996 - Buc suffered an aneurysm leading to a giant inter cranial subarachnoid hemorrhage of Hunt & Hess Grade 4-5 while playing tennis. She collapsed on the court at about 2:30 in the afternoon and is rushed to UCLA, undergoes evacuation surgery by 10 PM and aneurysm repair at 1 AM. She is wheeled into ICU by 5:30 Sunday morning. She has cleared 85 percent mortality at this point and has received the best surgical treatment in the world utilizing the latest in Guglielmi detachable platinum coils. UCLA assumes the most aggressive therapy, called Triple H procedures, sparing Buc from the usual damaging affects of 21 days of vaso-spasms. This is the period of time that the brain clears itself of free red blood cells outside the vascular system. Statistically, Buc has as high as a 45 percent good to excellent recovery because of these new procedures (less than three years old) when before, patient mortality was 100 percent and thus three years ago, victims of large inter cranial hemorrhages received only "patient comfort measures".

TUESDAY, DEC 31st - Justin and I are ringing in the New Year with our beloved Buc. We are watching them blow up the Las Vegas Landmark Hotel at midnight. It's funny, with all this hi-tech equipment in Buc's room, one clock says 12:03, one 11:59 and the TV, 11:59. Buc sleeps through it all.   This is the last day of Buc's COBRA.  It runs out at midnight.  Maxicare, who is in financial shambles, probably doesn't know that they are picking up at the year's end, an additional $300,000 in losses since Buc's COBRA was renewed.  All this is unexpected.  Buc was expecting yesterday to be hired permanently by Metior Corporation and to start off fresh with new coverage.  Now, she is oblivious to this, her head bandaged, her eyes shut, her future hanging in uncertainty.
 

Friday, Jan 10th - At UCLA, Dr. Sloan informs me that she has nearly 100% irreparable brain stem damage. This means that she will probably not see or walk, and he suggests that we let her go by taking her off life support no later than the following Tuesday. UCLA can make no long-term prognosis at this time.
    I believe that the stage has already been set by the UCLA physicians to close out this patient.  Note this following document.  It is in my handwriting.  UCLA did not want to provide an official, certified, institutional copy in the hands of the family as a paper trail of abandonment.  I find it amazing and totally ethically wrong not to provide a comprehensive and precise document as to this patient's condition, to the patient or patient's family, after charging over $300,000 in services, and for a patient of this caliber of injury.  In my view, it is the initial ramification supporting the notion, that UCLA would like to make sure that any and all responsibility to this patient is difficult if not impossible to ascertain.

    Clearly, such a document, rather than amassed and provided by the patient's spouse, should come from the institution providing patient services.
    Be aware, five years later, the patient cannot talk, but can communicate with her eyes, head movements, and guttural sounds, so she is hardly chronic vegetative.  During these five years, she has had no UCLA support until last month, when she went to see doctor Dobkin, in charge of peripheral nerve programs.
    What he found was a patient who could communicate.  But rather than allying with the patient, he rose the bar, essentially sending us on our way with suggestions as to how we might facilitate better communication with the patient by using homemade alphabet charts.  He offered no prescription for pupillary tracking devices, nor revisit, nor program.  What in the hell do they think they are doing anyway, the Regents for operating such a facility who will operate and practice surgery without the real intent to provide all essential care necessary to the patient's recovery?  Guess what?  After they essentially condemning this patient, now they want more proof that she deserves more.  I think Dr. Dobkin wants her to write a letter asking for more help!  If so, her statute of limitations has not yet expired, but has been restarted, and it may be time to sue them.  They are so cruel in action and deed. 12/20/01

WEDNESDAY, JAN 15th - Buc's G-tube, J-tube and trach are installed in surgery. Her ICU doors are closed against infection.

DURING THIS TIME - Once, when Buc's ICU doors were wide open, two custodians, one with whisk broom and the other with dustpan, began sweeping the carpet just outside her door!

Tuesday, Jan 21st - I am supposed to meet with Kelly White who is in charge of UCLA outpatient affairs regarding Buc's possible transfer by Maxicare, her HMO, but she never calls me. I'm under the impression that Maxicare's Dr. Lee is applying undue pressure to bear on Buc's three physicians to have her transferred before she is stable or safe to move out of UCLA ICU.

Wednesday, Jan 22nd - She is lost for the day, UCLA telling me that she has been transferred, and Daniel Freeman Marina Hospital telling me that she is not there. In fact, unbeknownst to me, while signing documents at UCLA, she has been wheeled to an undisclosed room not more than fifty feet away, perhaps saving the HMO as much as $1,800 each day.

Thursday, Jan 23rd - She is transferred with a high 103^o fever, a skin rash over her entire body, arriving at 3:00 o'clock in the afternoon, and left alone and unattended in a cold Room 310, some distance down the hall from the nurse's station, her pulsatile stockings and therapeutic boots laid aside. When I finally arrived at 9:00 PM, the attending head nurse, Judy, unaware of her condition and without patient records or interfacility transfer summary, could only comment on "how cute her hairdo was..." I was sickened when I saw her lying there, looking like Mahatma Gandhi during an extended fast. For six hours she had laid in sheer neglect. This sudden change from aggressive neurological care to nonattendance coincides to the Maxicare's contractual assumption of care, which then continues uninterrupted for months, up and until Buc's move to Casa Colina.

FRIDAY, JANUARY 24th - Dr. Howard Chew, Buc's Maxicare neurologist enters the room without introducing himself to me, walks past me saying under his breath that "She's in bad shape" or something to this effect, pokes at her eyes and lifts and drops her arms, and then leaves. He seemed wholly unaware (or uncaring) that her hands and wrists were sore from IVs, and that her eyesight is normally poor and that her response delay (presumably related to her attenuated right side EEG) is about 4 seconds!
    Note that Dr. Chew was a UCLA alumnus along with Dr. Dobkin.

Later on I find out that he has related this to the rest of the family, that indeed he and I had engaged extensively in this regard, which we had not, causing family confusion, conflict and delay in making appropriate choices for a patient who can neither move nor speak for herself.

TUESDAY, JANUARY 28th - Social worker Carrolle Simien said that she had seen Buc's medical records with Dr. Chew's entry in his handwriting, "No brain stem injury!"

DURING THIS TIME - Buc's eyes are open, she is attentive and seems to be watching television, this being her only therapy. Justin and I came in one evening and find her TV set is gone! I point this out to the nursing station attendant, building maintenance is called, but the fellow in charge of maintenance doesn't know why the TV set is gone, asserting that his supervisor would have to approve its removal. I ask him if his supervisor has the doctors OK; telling him that her TV is not for entertainment but therapy --her only mental stimulation at the time. He doesn't know. I ask him if his superviser is trained in medicine and ordered its removal. He doesn't know. Suddenly, a major nurse bounds around the corner, apparently having caught an earful, explaining that they needed Buc's TV set for a nurses meeting, and since Freeman is at full house they used Buc's, but will immediately replace it. I didn't think that they were going to accept responsibility until I really pinned this pure fellow down, which I had to do.

TUESDAY, FEBRUARY 4th - She is in Rm 410 at Daniel Freeman Marina. Tibor visits for the third time. Her physical appearance has greatly improved, her eyes are open more and she seems barely cogently responsive.

WEDNESDAY, FEBRUARY 5th - She seems considerably down as she enters the first stages of dehydration.

THURSDAY, FEBRUARY 6th - Considerably worse, Buc's hands are shriveled from dehydration.

FRIDAY, FEBRUARY 7th - Justin and I arrived at 9:00 PM and her breathing is short (panting) and she is too hot. She is completely dehydrated and unable to maintain correct body temperature. Roy (nurses assistant) discovers this with us and is alarmed and notifies the staff. Buc's heart rate is dangerously high! They immediately take measures. Backup physician Dr. Goldberg arrives later and orders her back into ICU.

SATURDAY, FEBRUARY 8th - In ICU, she has a fever and is not alert.

MONDAY, FEBRUARY 10th - On this early morning visit, Buc slowly awakes to my voice, turns to see me, and then turns well to her right to watch nurse Carol through the ICU window. There is no sound coming through the glass, so I know that Buc is tracking her eyes by sight, rather than by sound. She also briefly squeezed my hand with her right hand. Dr. Lieber told me that all her cultures are negative, bleeding from bowels minimal (probably stomach ulceration from her medication), that she will probably be removed from antibiotics, and that no wonder her kidneys seemed irregular, "yours would be too if you were dehydrated like she was".

TUESDAY, FEBRUARY 11th - Dr. Dea calls me about doing an upper colostomy to see if blood is coming from the stomach.

WEDNESDAY, FEBRUARY 12th - Justin and I arrive just before 8 PM. Phylis (RN) and Jill (Student Nurse) are just finishing in her room. Justin and I go to the commissary to wait until they're through. About ten minutes later, we go in. The room is noticeably stuffy and warm. Justin walks over to Buc first, then turns to me excitedly saying, "Dad! Mom is breathing again like before". Surely she is panting and again very hot, this time beads of perspiration on her forehead. She is not dehydrated this time, the room is hot; indicating that her hypothalamus is again working trying to cool her body down, Dr. Chew!.

Remember, Buc is still in isolation. Everyone must wear a gown, mask and gloves, and her door remains closed. Note also that there is no operable air conditioning on this wing, with mostly all the other patient doors open. During this whole escapade, one of the nurses had mentioned to me that they had inadvertently left the heating lamps on, using them as standard illumination with her doors and windows closed shut.

Justin and I, in panic, for fear of an escalated heart rate again, call the nurse's station where we are met with a rather disinterested and seemingly impatient, if not annoyed, Head Nurse Cobra on the phone, indicating that they might get there sooner or later! Eventually student nurse Jill arrives, being very conscientious. There is no usual cooling blanket machine with anal thermometer in place, nor for that matter, any thermometer in the room. Jill is visibly panicked, calls to ask where a thermometer is, being told by, I presume, Cobra that there must be one in the room someplace. She can't find a thermometer of any kind and calls again. In the meantime I ask if I may have permission to open the window, since Jill has closed the door. We are all so hot and perspiring inside our gowns that Justin must go outside. (He was sick for several days because of this.) It takes from 8:15 to 8:45 to find a thermometer, handed to me by Cobra who is not dressed to enter. I hand it to Jill who takes Buc's temperature which was high, but I am not sure what her temperature was, since I am now on the phone trying to reach Dr. Sprau in order to get permission to open Buc's window. It took three calls to get Dr. Sprau that night.

Eventually, maintenance rolled in a cooling blanket machine and Cobra sent down an air-conditioning repair man to see if he could fix her air conditioning. He was going to remove the vent above her head in order to see what the problem was. This was strange since the whole wing seemed warm and without air conditioning. Nurse Carol, several days before, in ICU complained about the same thing. I personally believe that the hospital simply was trying to save money by not operating all utilities. I told him that he should not pull maintenance in a patient's room without necessary precautions, though I don't think he understood this nor cared. I asked him to leave. He did.

I then went down to the nurse's station to lodge a grievance, asking them for the necessary paperwork. The nurses said that there was nothing like that, though they seemed a bit mixed up by the matter, eventually handing me a pre-printed

Daniel Freeman form, which indicated that nothing that I write down on it may be duplicated or distributed. I have this as evidence. They were neither engaging nor cooperative in this procedure. Cobra tried to assuage the whole matter by telling me, "The reason she's here is because her temperature spikes". Great! Cobra, that's another reason to put her in a hot box! (Concurrently, Cobra sent the repairman back to Buc's room while I was at the nurse's station filling out this grievance.)

When I returned to Buc's room and opened the door, it banged into the repairman's stepladder. He was still trying to remove the vent, literally ripping the ceiling plaster out. Even with my mask on, as I entered her room, I could smell the musty odor of air-conditioning dust. He had not draped the room at all and Buc was sleeping on her back with her mouth wide open to the falling dust! I asked him to stop what he was doing and leave. He did so again. Moments later, an angry, forceful and assertive Cobra arrived, and tried to make me leave the room, forgetting that she should not enter without mask and gown. I told her that the repairman will not subject Buc to these conditions, and if she didn't like it to call Dr. Sprau.

Before leaving for the evening, Justin, sick, and I emotionally drained and physically exhausted, discovered that the newly arrived cooling blanket machine is malfunctioning, its LED display indicating that it should be returned to maintenance. Jill ordered another and Justin and I went home. It was about 11PM.

THURSDAY, FEBRUARY 13th - From 5:01 until 11:15, I am with Buc. She is watching me the whole time as I talk with her. It is a good night. Phyllis and I discover that the second cooling blanket machine is off by 2^o C, measuring 39^o against a calibrated thermometer measuring 37^o.

FRIDAY, FEBRUARY 14th - Dr. Friedman told me that Buc's kidneys are OK. Dr. Dea checks out her stomach at 3:00 and discovers that the surgical balloon anchoring her G-tube is too low and is blocking her pylorus. He has it slightly deflated, and her stomach begins to discharge liquid into her duodenum, where before, it was discharging the wrong way out her G-tube. It is possible that this may have contributed to her dehydration earlier. I sobbed in the social worker's office, thoroughly beaten by the professional ineptitude and callousness, as though they were mechanics working on a car.

SUNDAY, FEBRUARY 16th - I tried to talk with Dr. Lieber in the hallway outside Buc's room, but he seemed disinterested, dismissing himself when I asked more questions regarding her condition, saying, "She will probably be moved." During this conversation, he indicated that the best place to move her, with the type of care she will need, is down the hall, which was never mentioned to me by Dr. Gramer, who insisted that Brotman Hospital in Culver City and Casa Colina in Lomita were my only choices. I had selected Brotman, but eventually Gramer informed me that Brotman decided not to accept Buc because she required isolation and that Freeman couldn't keep her.

Today, May 14th, I have come to realize that the HMO had another provider in Santa Monica which had not been mentioned to me by Gramer, the St. Johns Westside Network Medical Group on 22nd Street. We live on 20th! No doubt through misinformation and the inconvenience of travel, the family would be kept on the run; unable to make good decisions in the process. (Remember our founding Father Benjamin Franklin, the Crown trying him for treason in England; the same techniques haunt us today.) Both our cars sit in the shop for repair; both breaking down within days of each other. My son's car blew a main bearing and cannot be repaired.

MONDAY, FEBRUARY 17th - Dr. Dea was cleaning out Buc's constipation, no doubt brought on by the lack of fluid moving into the duodenum. He re-confirms that her stomach blockage was caused by improper placement of G-tube balloon. He said that the J-tube was OK.

2/12/97 (WED) 1:05pm 829-3130 - Inform Dr. Gramer that I would like Chew removed and replaced by Alexander or outside specialist. He will be gone until Friday. Friday I could not call Dr. Gramer because I was too busy at work.

2/17/97 (MON) 5:23pm 829-3130 - Informed Dr. Gramer that I would like Chew removed and replaced by Alexander or an outside specialist. He seemed very unprofessional and clumsy in his response to me, though I was following Maxicare's prescribed procedure in the matter.

2/18/97 (TUES) 348-7800 x450 - Called Integrated Physicians to have Chew removed. They instructed me to again call Dr. Gramer at 829-3130 about this.

2/18/97 (TUES) 829-3130 - Dr. Gramer gone for the day.

2/18/97 (TUES) 5:15pm - Dr. Chew calls me for the first time saying that he was not that familiar with Buc's records and hadn't seen her charts. He still thinks that she is chronic vegetative. (This is but three weeks since Buc has been Chew's patient.)

TUESDAY, FEBRUARY 18th - Dr. Sprau dismisses herself from the case without warning.

TUESDAY, FEBRUARY 18th - Buc's temperature was 38.7^o to 38.4^o. Cooling blanket was too cold (icy) and her room too warm. We placed blanket between her body and the cooling blanket because she was fighting chills. (Now I know why she was losing so much weight; burning up calories to keep warm!) She held a perfect temperature at 38.4^o when the auto temp was changed from 37^o to 37.5^o, 37^o being way too cold for her. The nurse later came in and fussed with the machine when I asked her if it was accurate. She repeatedly turned it on and off as though being uncertain of its operation. Later, when I was about to leave, I noticed that the cooling blanket underneath her was warm. It was also warm completely away from her body and there was warm water in the supply hose leading to her, despite her temperature being 38.7^o. Since 38.7^o is threshold hot, the high limit being 39^o, the blanket should have been cold instead, preventing her from passing this threshold set at 37.5^o!

THURSDAY, FEBRUARY 20th - Posie and I attend a nurses meeting called by social worker Carrolle Simien. Besides the three of us, two other Freeman nursing staff attend and a nurses union rep, the latter coming in late and acting distressed and defensive. The meeting was supposed to last fifteen minutes, but they kept asking me more questions, and it went on for forty-five minutes. There were many problems concerning nursing work load imposed by the HMO (6 patients to each night nurse), knowledge in operating some of the hi-tech equipment they use, and sanitary measures. I brought up that I thought that the nurses should be better trained in the handling of invasive equipment, particular tubes carrying nutrition and medications to the patient and how one night, one nurse was unable to suction Buc who was in respiratory distress because she was unable to turn on the vacuum pump. As I sat there watching her attempts, I noticed that the effluent reservoir was filled, thus disabling the motor. Reaching down in order to remove and replace the reservoir, which lies very near floor level, she drags the sterile insertion catheter along the equipment base and floor, then uses it. I was appalled, but it was too late!

The rep responds to this by saying that I have every right to bring this to the nursing staff's attention, despite my protesting that this is not my qualification nor job. She insisted that I have every right to do so and should. OK I said. Would you recommend that the next time that I am in her room visiting and a nurse knocks off a sterile device inside its protective, sealed container on to the floor, tries to pick it up using a sweeping motion across the floor, touching her gloved fingertips to the floor as she does so, that I should tell her to discard both gloves and container (usually a flat bag) and start over? She never replied, which happened to be the hot topic of discussion among all of us after the meeting adjourned, the two Freeman administrative nurses in attendance smiling and shaking their heads in disbelief at the union rep's evasiveness during the meeting. Posie said that I handled myself very well under the circumstances.

THURSDAY, FEBRUARY 20th - Chew makes his second visit while I am in attendance trying to convince me by darting his fingertips towards her eyes, that because she does not blink her brain is functioning at a very low level, not responding to threat. I try to explain to Chew that Buc has been showing a delayed response and that her eyesight has never been that good. Also, it is evening, and the room is not lit well enough for her to see his small fingertips. When I ask him about specific things, such as the status of her brain stem injury, he gruffly reminds me that it is fine, otherwise she could not see. At some later date, unknown to me, he tells Posie and Maresy that she is blind! Just for the record, by now, many times I have placed a cold compress on Buc's forehead to cool her off, and she normally reacted with her eyes as I brought this towards her face.

2/23/97 9:30am 453-1414 - Called Dr. Lieber to delay any move. Did not call back all day until late and left a message as to when she will be moved, despite my wishes to the contrary.

2/23/97 (SUN) 829-3130 - Dr. Gramer gone for the day. Usual backup Dr. Greenspan not current backup. Suggested to call Gramer 2/24/97.

2/23/97 (not sure of this date) 823-8911 x4169 -Called social worker Carolle Simien to find out why Chew withheld important facts.

2/24/97 829-3130 - Tried to reach Dr. Gramer to have Chew dismissed. Stephanie took my message (slow down sir!). Gramer gone until noon. (Of course then he gets his usual two hour lunch. So technically, if I called at 10:00AM, I won't be able to reach him for at least another five hours!) He has no assigned backup including Greenspan.

2/24/97 10:03am (213) 742-9955 - Waiting! 10:18 Problems with pharmacy?

2/24/97 (213) 365-3494 x3257 - Grievance to Maxicare, Frank Kasperzyk. Reached voice mail only.

(Some of the previous dates seem wrong to me, though I remember making these calls. Somehow I feel none of these calls had been made on the weekend. My handwritten scheduling calendar at my office may have been wrong.)

MONDAY, MARCH 3rd - Dr. Gramer informs me that no neurologist is assigned to Buc. I am greatly relieved that Chew has been removed.

TUESDAY, MARCH 4th - Justin and I escort Buc's ambulance to Casa Colina. They however get lost, taking Western into town. Casa Colina had a great deal of trouble connecting Buc to their wall oxygen, the pipe being somewhat loose inside the walls of the room.

WEDNESDAY, MARCH 12th - Justin and I meet with Casa Colina social worker, speech therapist and physical therapist. They seem to have no confidence in Buc's outcome; riding on Chew's misdiagnosis.

3/16/97 5:00pm -The nurse at Casa Colina calls me to tell me that Buc is gnashing out her teeth and bleeding but apparently calls no one else. I suspect that they had already put this through normal channels and had rebuffed by the PCP as it being of a dental matter!

MONDAY, MARCH 17th - I bring Buc oral spray and a baby's pacifier. There is some confusion by the medical team as to what to do about this. Buc's tongue is still coated with an opportunistic yeast infection and I see little sign of oral hygiene having been carried out; no saline drip in place, virtually nothing. No bite block has been ordered, though Dr. Lieber at Freeman, said that he will recommend it. Something is really missing now in Buc's continuity of care.

TUESDAY, MARCH 18th - I heard from L.A. Post that Maxicare is no longer operating in the State of California; leaving as of the end of this month. No wonder Gramer told me that I was in charge!

WEDNESDAY, MARCH 19th - Dr. Grossman recommends that you have a mouthpiece.

SATURDAY, MARCH 26th - Buc's feet were a mess. Her pulsa-tile stockings were too loose, with enough space to insert a 2" dowel inside. Her support hose were compressing her toes so much that they were purple and her veins collapsed. Her skin was reacting to their incessant presence. I removed everything, washed and massaged her legs and feet, and applied lotion.

SUNDAY, MARCH 27th - Buc's feet were much better. She was greatly distressed today, severely gnashing her teeth. Her swallowing is strong and blow-by excessive. It is definitely time for the trach to be removed. She squeezed my hand once, very hard, on command.

3/27/97 1:35pm 829-3130 x369 - Left message to activate misdiagnosis grievance to case worker Kim Brown. She returned call and is no longer Buc's case worker, Kathy Moore is.

3/27/97 1:37pm 348-7800 x450 - Left message with new case worker Kathy Moore. No response.

3/27/97 1:51pm 829-3130 x5 - Called for medical records three times by redial. Mailbox full. Forced exit twice "good-bye".

3/27/97 2:30pm 829-3130 - Called for medical records. Maria says call Robin at 348-7800 (Utilization Review Committee).

3/28/97 10:00am 348-7800 x369 - Kim Brown called.

3/28/97 2:52pm 829-3130 x351 - Robin Taylor, Maria Rodrequez. Supervisor needs to release records. No patient records at Prairie Medical.

3/28/97 4:15pm 829-3130 x4274 - Requesting skull x-rays of jaw. Monique said that none are available.

3/28/97 3:30pm 825-6425 - UCLA radiology (Martha) at first refused but then said that there was no x-rays of Buc's jaw.

MONDAY, MARCH 28th - Justin saw Buc today. He was amazed at her response, as she turned to look a Maurice Lucas' photo on the wall when he mentioned his name.

TUESDAY, MARCH 29th - Buc blew an eyelash off Justin's finger that he had just plucked from her eye. He told her to make a wish and blow! He said you blew for ten minutes and they all laughed. Again she found the pictures of interest when they were mentioned in conversation. Justin, his friend Jason, and nurse Ruth witnessed this.

3/31/97 1:45pm 829-3130 - Inform Dr. Gramer that Buc is emotionally distressed and is gnashing her teeth. Felicia will tell Dr. Gramer.

3/31/97 2:00 1-800-234-6294 - Inform Maxicare. PCP will handle it.

3/31/97 2:30pm 829-3130 - To remind Gramer. Gramer will speak to UR.

3/31/97 5:30pm 829-3130 - To determine if Gramer brought this up with UR. Maria will remind Gramer to talk to UR, Traughber and Kawai.

4/1/97 2:15pm 377-2223 - Receptionist will relay message to Dr. Kawai to remind Traughber.

4/1/97 2:18pm 541-7911 - To inform Traughber . Attendant didn't like taking a long message.

4/2/97 11:10am 541-7911 - Checking in to find out if Traughber has issued any orders. He's gone for the week.

4/2/97 11:12am 829-3130 - Kelly puts me through to Gramer who is not there, Stephanie understands the urgency and suggests alternative backup Greenspan. I wait on the phone from 11:13 to 11:20. Nursing Supervisor Veronica Kemp picks up and says that they will do something, bear with us, she will talk to Greenspan.

4/4/97? 3:30pm 829-3130 - Calling to move Buc closer to home. Kelly, very polite, takes message. It's official.

4/4/97? 3:35pm 541-7911 - To talk to Traughber about trach removal. Connie took the message, she was very nice.

4/3/97 10:50am 800 400-0815 - I make grievance with Dept. of Corp.

4/4/97 3:20pm - Linda Azzolina, attorney for the Dept. of Corp. calls me to inquire as to what is going on.

4/4/974:15pm - Dorothy Oda, Special Nurse Consultant for the Dept. of Corp. calls me to inquire as to what is going on.

4/4/97 5:25pm - Phil Cooper, Maxicare's Member Services Manager calls to find out what is going on.

FRIDAY, APRIL 4th - Mobile X-ray unit goes to Casa Colina and x-rays Buc's lower jaw. There is no sign of a fracture from her fall Dec 28th, when she landed on her face.

4/8/97 10:25am 541-7911 - Inform Dr. Traughber the Buc is clammy with fever, trach is bloody and has not been change and to notify nurses to guard her condition. It is his day off and he is not in his office. Dr. Goldbar is covering I am told. They will have Traughber return call. Sometime later Janice calls back to tell me that Buc should come in. Much later, Traughber calls back.

4/8/97 10:28am 829-3130 - To ask Dr. Gramer to oversee trach removal but he is off. Maria says that Greenspan is seeing patients, but will return call before noon. Greenspan returns call and we have a good discussion.

4/8/97 10:30am (213) 365-3201 - Phil Cooper is notified at Maxicare that physicians needed are unavailable. He is out of his office and I left a message on his voice mail.

4/11/97? 3:36pm (213) 365-3201 - Call Maxicare's Phil Cooper to move Buc closer to home and to assign her a neurologist. His voice mail only saying that he will return call 4/8/97.

4/16/97 2:05pm (213) 365-3201 - Call to tell him that I received his letter responding to grievances to Dept. of Corp. but that things are still not OK. I left message and he responded by 4:30 the same day and will try to improve the situation.

4/16/97 2:10pm 541-7911 - Inform Dr. Traughber of Buc's filthy stockings and to try to determine trach status. Attendant will leave message in his box. Attendant doesn't know his rounds and he may not get this message until Tuesday!

4/29/97 9:20am 325-3202 - This is Dr. Traughber's morning to visit Casa Colina. The phone receptionist Glenda Jones copes an attitude, "I'll have to page him! She returns telling me that she can't find him. I tell her to connect to nurse's station outside 109..."I'll have to page them, too! I talk to Elizabeth who tells me that when Traughber is out of his meeting, he will call me; which he never does.

4/29/97 11:30am - Phil Cooper calls me in response to Dorothy Oda's call to him. He will look into Buc's trach removal.

4/29/97 11:30am (510) 235-9459 - Advised Dorothy Oda of Phil's response. He seem more worried than concerned for Buc.

4/29/97 3:15pm 325-3202 - Called Janet Miller at Casa Colina to inquire about AM meeting with Dr. Traughber. She was on the phone but they would have her return this call, which she did not do.

4/29/979:15pm - Dr. Traughber called me at my home. He said trach removal was OK and that he will check with Mary Giffen.

4/30/97 10:30am 325-3202 - Left message with Mary Giffen. She has never returned this call.

4/30/97 2:25pm 325-3202 - Left message with Mary Giffen. She has never returned this call.

4/30/97 4:05pm (510) 235-9459 - Called Dorothy Oda for consultation in trach removal matter.

4/30/97 4:20pm 325-3202 - Talked to nurse Blanca at Casa Colina. She assured me that it is scheduled to be done within a few days.

SUNDAY, MAY 4th - Buc's room is very warm at Casa Colina. She has beads of sweat on her forehead, her back is soaking and her mattress drenched. I call for the attendant to change out her underpadding. Her lower incisors are in great disarray as she is indicating greater distress to either her condition, surroundings, or both. The level of distress can be significantly attenuated by effloraging her head and neck. I believe that the removal of the trach and its corresponding strap which has been cutting into her neck for three months will reduce her distress. I contract food poisoning eating at El Pollo

5/6/97 3:15pm 541-7911 - Called Dr. Traughber to inquire about trach removal. Leslie said she will call me back in about a half an hour. She didn't.

5/6/97 3:20pm 325-3202 - Spoke to Mary Giffen at Casa Colina. She said Traughber had never contacted her in this regard. She also mentioned that Buc's therapy has been discontinued.

TUESDAY, MAY 6th - Nurse Blanca said that she held off ordering trach removal, because Buc had cold symptoms. I told Blanca that I was very alarmed about the build up of puss (I cleaned up) and the condition of her tissue surrounding the trach. They were cooling her room with a fan all day and her lips were badly chapped and peeling.

5/7/97 1:15pm 325-3202 - Called in regard to trach removal: Janet Miller is not there, Mary Lother is with a patient and Mary Giffin is busy.

WEDNESDAY, MAY 7th - Justin explained to Nurse Blanca that the south facing rooms, such as Buc's, are warmer than the rooms on the north wing. Blanca said that all rooms are the same.

WEDNESDAY, MAY 7th - Buc's trach has been removed.

THURSDAY, MAY 8th - Buc is much less distressed and very alert when I arrive. She seems focused on an older woman patient mistakenly trying to enter her room. Later in the evening, she vomits bile (yellow) all down her blouse. I'm distraught that she might have inhaled some into her lungs. Ruth said that the air conditioning is working. It was not.

FRIDAY, MAY 9th - Janet Miller calls me from Casa Colina (8:00am) to chat. We had a nice conversation.

WEDNESDAY, MAY 14th 11:45am - I return Carmel's call to me from Casa Colina. She tells me that Robyn (Buc's case worker) said that Buc's coverage was retroactively terminated April 1st. I was shocked saying that Robyn does not work for Maxicare. Carmel said that she works for Prairie Group, which is correct. I told Carmel that I should have this in writing. "No way! It's not going to happen Mr. Webb; we need to know today"!

WEDNESDAY, MAY 14th - This evening I visit Buc and meet James in the hallway at Casa Colina. He said that Buc talked! They were standing in the hallway at the nurse's station outside her room and heard someone calling for help They couldn't imagine who it was. After all, Chew had labeled Buc sub-acute coma, chronic vegetative-permanently disabled. Investigating the calls coming from her room, she was actually calling for help because her head was tilted to the side and she needed someone to help push it up. (She can sometimes do it herself, but is still woozy from the whole situation and doesn't always repeat.) Later, nurse Ruth says to me, "Buc talked", repeating the whole story.

I have Buc sitting very upright, which helps release the phlegm caught in her healing trach wound. She seems thirsty to me, repeatedly pursing her lips and licking them with her tongue. Remember, she has not had a drink of water for five months! I give her a small amount (a few drops) administered by Q-tip which she enjoys, sucking on the Q-tip and strongly swallowing. Water is not the best thing to give her because it is thin, and can work its way into the lungs or cause some gastric distress.

I ask Ruth if they have anything better to give her. She tells me the kitchen is locked and that nothing has been prescribed for her.

WEDNESDAY JUNE 11th 1997 - Maxicare has rescinded its orders to release Buc on the pretense that she will receive a second chance. They assure me that things will indeed be better. Eddie, the records nurse calls to find out where her dental records are. It is a warm day, so her room could be conceivably warmer than it's been. I ask him if it is warm down there. He replies that it is and then proceeds to extricate himself from the ensuing sequence of meaningless replies, concluding that her room has air-conditioning and that she is not warm and OK. I am so tired of being met with this third-world blather. That evening I arrive at Casa Colina. Buc is lying on top of her sheets to her right, in a trance, staring at the wall. She is wearing anti-embolism stockings. She is hot and drenched, so drenched that droplets are rolling down her temples and her palms and wrists. I stabilize her with cool compresses and dry bedding and gown. Upon removing her anti-embolism stockings, which were also keeping her warm, she was left with creases and markings around her thighs from their elastic. Eventually her temperature stabilized and she enjoyed sucking water from an applicator. I asked nurse Blanca if she was coming down with something, and she said no.

THURSDAY JUNE 12th 1997 - I couldn't make it today and called 109 at eight PM. The attendant seemed impatient with me inquiring about her condition, but did mention that her TV was turned on to channel seven.

SATURDAY JULY 5th 1997 - I arrive early to watched Wimbeldon ladies finals. From 9:00 AM to 9:45 AM. Buc is involved with working her one loose incisor, though I don't realize this because she is not making any sound by grinding. It is real loose. At 9:45, she gulps, gags, and bolts upright, coughing and with an immense amount of saliva flowing from her mouth onto her front, I realize that she is choking. I hold her head more upright, assuming that it might be her incisor, which was very loose the night before. I am alarmed and fear that she might choke to death. Because I am occupied holding her head, I can't reach her call button. After she calms down, I get nurse Rose's attention. She is quite busy with paperwork at her station, and hesitates, nor really quite believes anything that I tell her. She expresses doubt that Buc just ingested her tooth. Even though I tell her that if it was there the night before, is not there now nor in her mouth, and if she really doesn't think that Buc has ingested her tooth, then it might be prudent to search for it in her bedding just to make sure. She says nothing and leaves and returns to her station outside Buc's door. This all took a lot longer than you might think, because by 11:00, with my prodding and insistence that she call doctor Traughber (which she at first refuses to do until I say that if you won't I will), she reluctantly makes the call. Even then, she minimizes everything to him, causing him only to order a chest x-ray. He should have come in and they should have order a throat x-ray, though at the time, I was not aware of the limited scope of their professional reaction to these conditions, which could have well been anticipated over the many months (See 3/16/97 entry.)

Eventually Rose calls for mobile x-rays and returns to tell me. I ask her when they are scheduled, realizing that Buc remains in some distress and that something is different about her swallowing and breathing. Rose does not know when. We continue to argue the matter, Rose's level of professionalism falling far below what I provide in my profession which does not involve itself with life and death situations, or even conditions which might lead to this. To not be able or to know when something is scheduled, to be unwilling, unconcerned, disallowed or unable to mandate such scheduling (she placed blame on the x-ray provider) is indefensible. Not only was she unable to schedule, she was not even sure if it would be done today, saying that it is the weekend.

Throughout the balance of the morning, I remained at Buc's side, ashamed that all this happened in front of her, aptly pointed out by Rose for which I give her credit.

Several times Rose and I met beyond earshot of Buc's room. Rose tried to tell me that Buc was never in distress and that if her tooth came out when I said, her gum should have been bleeding. I declined to rebuff her medically that the tooth may have been hanging by a thread, any traces of blood thoroughly leeched nor remind her that "distress" is relative to both the patient and conditions surrounding the patient. If you or I swallowed a bone or tooth, the latter having at times proved fatal, we have the option to drink liquids or eat bread to wash them down, as well as the emotional comfort to call for help and move ourselves out of a lying down position, whereas as Buc enjoys none of these options. I eventually leave for the afternoon, returning that evening.

The night nurse is on and shows no interest in the day's earlier developments. She also seems not to enjoy being asked about the x-rays, telling me that they did take them, but that no results are in. She tells me she will call at 8:00 PM to find out. Buc is still different and so I am still greatly concerned that her tooth might still be lodged someplace near her windpipe. I go back down to the nurses station at 8:10 to find out about the x-ray report. The one chest x-ray is negative. I ask the nurse if they shot her throat area, or only the chest. She is unable to answer and unwilling to make this determination. It is now 8:30. She demonstrates no further concern for this matter.

SUNDAY JULY 6th 1997 - It is our 22nd anniversary. I arrive at about 9:15 with tuberoses and sad heart. Buc's still seems different in her coughing and has more of a fever and more phlegm. Perhaps the tooth is dislodge but has injured her tissue. Our day is a reluctant and sad celebration of friendship and love. I am an emotional wreck.

MONDAY JULY 7th 1997 - I am too distraught to see her. I call in around seven, Kathy answers. She's great. Buc has great confidence in her and looks up at her when she comes in the room. Kathy relays the message to Buc that I won't be coming.

TUESDAY JULY 8th 1997 - Buc is better, her fever and phlegm reduced. Occasionally she coughs as though something is wrong. Once her facial expressions became greatly contorted as though she was feeling suffocated. I had been trying to get us to communicate more but was getting the nagging feeling that something is working against it. After seeing her repeated distress, I tried to communicate by asking her to answer yes with her fingers: extending her fingers slightly on her right hand signifying "YES". No action means "NOT YES", which might be maybe or uncertain, I can only presume. It is also important to hold her arm gently at her wrist so that she can as well witness her fingers moving; she does better. I then proceeded to ask her if something seemed to be caught in her throat. Her fingers quickly and boldly extended. I almost cried, and kissing her hand, I said, "thank you, thank you, now I want you to do this for Kathy."

Kathy was down the hall and I told her what just transpired. This time she held Buc's wrist and asked her own set of questions, Buc answering NO to her sore throat question. Kathy realized that the patient was directly telling her about her symptoms. "Now do we call the doctor", I asked. She agreed that her throat area be examined and said that the doctor will be coming in the morning.

WEDNESDAY JULY 23rd - Buc is taken to Freeman Marina at 9:00 AM for her first Magnetic Resonance Imaging (MRI). It was her good fortune that the nurses told of this in advance. We both arrived at Freeman at the same time, she by ambulance and I by car. "You must be the husband", one of the ambulance drivers said, as I approached her in the foyer. She was soaking wet; drenched in perspiration. They wheeled her into a very cold storage room inside radiology, where she waited her turn to go into the chamber. She was transferred to a bed directly underneath some sort of equipment which was blowing cold air down on her. By now, her shirt was icy cold. I asked an assistant radiology technician if we can dry her and change her out. He agreed and we did so. Her feet were cold and I rubbed them. We waited here about forty minutes. The radiology technician was surprised that she had not been accompanied by a nurse from Casa Colina. Again, no intrafacility transfer summary followed her. Later, I accompanied Buc into the chamber, and saw her first MRIs. Though, wouldn't you guess it, the technician operating the MRI, was not allowed to comment on anything we saw. She eventually concentrated her scans to a particular area low down on Buc's right-hand side, where a white anomaly stood out: a sort of diffused spherical region of white specks, obviously the remnants of her SAH. It measured about 2/3rds the diameter of her right ventricle. The C-scans of January (which I have in my possession) show the same ventricle exceeded by about 1/3rd its diameter by the SAH. What this means is that the SAH is still there and able to affect neurological function, but greatly reduced to about 10-20% its original volume. What this means is that BUC is healing and reabsorbing the SAH into her system.

SATURDAY JULY 26th - Casa Colina, about 3:30, I find her strap in her wheelchair with her head pulled back by an ordinary elastic strap (1.5"). It is pulling her left eye back so that she can hardly blink. When I utter a complaint, day nurse Rose walks away. Michelle listens, but says that's not her job. Margarita says that she put Buc like that 45 minutes ago and that she will remain like that a bit longer. That does not happen as I release Buc from the straps.

SUNDAY JULY 27th - Buc is slouch over on her right side with her neck crunch at ninety degrees. She is fully covered and drooling all over her blouse. She is perspiring and distressed. Again, everybody denies responsibility based upon shift change and job duty. Day nurse Saria says that she will note this in a log they keep, not the patient's records. This may be the start of the setback escalating from the Freeman trip.

SATURDAY AUGUST 22nd - Maxicare announces that they will no longer be covering Buc. This is based upon her last MRI.

TUESDAY SEPTEMBER 2nd - Michael Petherick from the DOC informed me by phone that their independent examiner ruled in favor of Maxicare. I may have to pay either directly or indirectly for her care at about $2700 per month retroactive to August 22nd.

JANUARY 8th 1998 - I sent a letter to Mr. Warren Foon, Vice President and General Manager of Maxicare of California, Incorporated concerning a wide range of faults, including Buc's bed at home which they provided by law.

WEDNESDAY MAY 13th 1998 - Called Donna Slimak at (818) 228-2582 to explore the possibility of having Buc's G-tube looked after. She will be gone until Friday. Talked to her assistant who said that she will get back to me as quickly as possible. She suggested that I might call Customer Service. I called Customer Service at (800) 827-2273 in order to talk to Diane Taylor, Buc's newly assigned Case Worker. I left a message with Lenoir Press voicemail. About forty minutes later, Debbie Burgio called from (818) 228-3177 to see what I needed. Besides discussing the G-tube replacement, which she said was covered, she told me that I may pick a new primary care physician to replace Dr. David Cutler. She is activating this retroactively to May 1st since it has been over two months ago that we met with Cutler. She also told me that Diane Taylor is no longer Buc's case worker since new groups have moved through, at that Lenoir Press is Buc's new case worker. Ms. Burgio is always available M-F from 8 to 5. She also said that I should pick a neurologist, also covered, and that speech and physical therapist should be selected, they too being covered.

THURSDAY MAY 11th 2000 - (Two years later)  Buc still lays in the same old bed which looks like it came out of WWII Pacific Theater and might have used for patients who are not going to spend too much time flat on their back recovering from shrapnel wounds. After many phone calls, letters and promises, they, the many HMOs managing her plan, along with their administrators and providers, have deftly dodged the fulfillment of this obligation and prepaid promise to the patient, no less than under the watchful eye of the Department of Corporations.

She is alert, paralyzed, and willing to press forward for more testing, evaluation and treatment which she never received throughout her ordeal.

In April 2000, Los Angeles Commissioner Gregory Evangelatos mentioned to me the existence of a pupillary tracking machine, costing $18,000, which might enable Buc to write poetry and letters, and change TV channels.  She was very excited to hear about this possibility, but being reclassified PCSP denies her any chance of DPSS/IHSS staff review, which under the intent of the law should be permitted, but which has been scuttled by Medi-Cal accountants and administrators.  Greg is very sensitive to her plight, because he is blind and an old friend who I have done many public service projects with for the disabled, such as the Los Angeles Summer Disabled Olympics coming up in July.  I hope that some summer, Buc will be able to participate in these games, hopefully playing her beloved tennis or basketball.

Had the insurance companies (Maxicare and CareAmerica) honored their contract with Buc, she would be receiving almost $25,000 in nursing costs they refused to cover, even though their Summary of Benefits provides such coverage.

In October of 1997, Maxicare releases Buc to come home.  Knowing the intensity of this patient's condition they could have offered extended care nursing for the balance of the year,  approximately $6,000 for two months at $3,000 monthly.  But they offered nothing, did nothing, nor mentioned their obligation.  Again, in 1998, they could have provided 100 days per contract year of skilled nursing or hospice services which comes to about $9,000, and again, with the plan moving to CareAmerica, another $9,000 would be accrued in the first quarter of 1999.  But they too, CareAmerica did nothing, despite purchasing Buc's plan from Maxicare.

A lot of folks suggest lawsuit.  But under the ARISA laws imposed by Congress, you cannot sue an HMO for damages or penalties, so what attorney would want this type of case?  Believe me, I've contacted many.  You see, most attorneys are in it for the money, and against the deep clauses in a patient's contract with an HMO, such as "...when Medically Necessary as authorized by a MAXPHYSICIAN", virtually eliminates this option, since everything is stacked against a patient who is recognized as a medical dead-end.

As you read this, can you justify it?

Imagine that you are this patient:  able to see, hear, think and understand everything that is being said about you, but unable to speak or move.  And though you might disagree with the medical findings surrounding you, since your breathing is disconnected from your brain, you cannot object.