Senator Dianne Feinstein
331 Hart Building
Washington, DC 20510
RE: Constance A. Webb, RFA 7478.
Dear Senator Feinstein:
Last week, I watched Governor Davis sign into law a broad measure of
HMO reforms. But what good is it, if the agencies enforcing such
regulations, such as California's Department of Corporations (DOC), can
ignore the law because of how they might interpret it?
For example, making reference to the California Code of Regulations
1357.08 Required Basic Health Care Services, subdivision (b), (d) Standards
1367: the plan shall furnish services in a manner providing continuity
of care". What is being referred to here is a health plan provided
by an HMO. The words you see in italics are not the exact wording
as printed in the California Code of Regulations, but my direct interpretation
of them, as citizen, lay person and spouse.
In regard to the nature of these services, I have provided the DOC
innumerable records of both the failure to provide services and appropriate
services. This has been done by applying formally to them for a Request
For Assistance (RFA). Ultimately, as I have found, if they deny these
RFAs, which they have done on several occasions, their reasons for denial
cite in any combination "insufficient evidence" or that the care "was consistent
with professionally recognized standards of practice".
So, no matter what laws you might make, a spouse's representation of
a patient carries absolutely no weight! Either the spouses factual
input is denied as insufficient evidence against the overriding admissibility
of institutional records, whose nature is supposed as sufficient evidence,
or that the spouse's opinion cannot rebuke the acceptance of institutional
standards nor medical oversight of any degree.
Once this happens, there is no second chance; the spouse's evidence
and opinion being discarded, as though subjected to courtroom procedure.
Treated as resubmitted evidence, they are not admissible in review.
Once this happens, there is no arbitration, no discussion and no explanations
allowed, since the person or persons making the DOC's determination are
deemed to be of secret counsel.
Once this happens, if there is error at the administrative level, such
as interchanging RFA numbers, or what I know to be misrepresentation of
the true facts of the matter, there are no mechanisms to correct this which
are available to the spouse1.
It also seems, because this process is bounded by statutory time limitations,
there is the proclivity to dismiss cases by any means, such as suggesting
that the spouse is no longer interested in pursuing an RFA, as assumed.
Usually this relates to not filling out and returning a Medical Release
Authorization form, in itself, seemingly innocuous, unless they throw these
forms at you one after another, using them as a device to summarily get
rid of cases.
There is also the tendency to suggest by those administering the enforcement
of these laws to seek other dispute resolution alternatives and remedies,
though none exist.
Even if actions are taken to protect the patient or other patients
against a plans provider, there are kept secret by law, as not being matters
of public record.
At this point, there is no recourse allowed within the regulatory limitations
imposed by the DOC. They say that my wife was treated well, I say
not. They say that she was not abandoned, though I know that she
was.
If I were to provide you but one shred of evidence out of many, supporting
my position, it would not be enough, and if I were to present you an entire
chronology of abandonment, it would be too much to assimilate. So
enclosed, you will find my September 5th letter to Acting Commissioner
William Kenefick, strategically comparing four points of law with events
and conditions concerning my wife's care.
But what good will this do?
One thing to remember is the dire condition of this patient at the
onset of Maxicare's takeover as the plan's provider, and how the label
"chronic vegetative" issued by their contracted physician, must have cast
a negative bureaucratic opinion, and hence the omission of regulatory action,
protecting this patient's rights under the law, and how this same patient,
acknowledged to her new physicians last week (by looking up to the ceiling
with her eyes) that she wants them to make her better.
Perhaps armed with these new realities, a phone call from you to Commissioner
Kenefick, might make the difference in her care.
Thank you very much for your concern and your help.
Sincerely,
Joel Webb
910-B 20th Street, Santa Monica, CA 90403 (310) 828-2292 (310) 829-0767