Acting Commissioner William Kenefick
Department of Corporations
3700 Wilshire Blvd., Suite 600
Los Angeles, CA 90010-3001

RE: Distillation and Rebuttal to closure of RFA 7478, letter of 9/2/97, file no. 933-0002.

Following are excerpts from original Chronological Summary of Events submitted to DOC June 4, 1997. Crossed-out are my opinions, impressions or comments. The complete Summary, which the DOC's Chief Administrative Officer retains, is sixteen pages and ranges in period from late December 1996 to September 1997. The DOC's letter of September 2, 1997 refers to these records as being insufficient.

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, Cobra, unaware of her condition and without patient records or inter facility 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.

In light of these revelations at the cutting edge of medical technology, I completely lack confidence in the DOC's knowledge about my wife's condition, both internally among their own staff of primarily attorneys and managers as public servants, but as well among their selection of third party specialists to review and rule on this RFA.

I believe my uncertainty rests in the knowledge, that my wife's surgical treatment was rare and generally unknown to physicians and medical workers.

This became crystal clear to me when many specialists and case workers told me that they had seen thousands (actually three-thousand was once quoted to me at Freeman Hospital) of cases like my wife's. Bear in mind, when Buc received her GDC surgery, Boston-Harvard Medical School, Irvine Medical School and UCLA had collectively treated less than 150 patients of grade V SAHs.

Again, I ask you to keep in mind the severity of my wife's injury. An aneurysm explodes inside her head at the basal tip, producing a subarachnoid hemorrhage (SAH), the size of a baseball, the brain being push to one side.

As part of post-surgical procedures, she must safely eclipse a twenty-one day period of vaso-spasms. This is true for most patients even with lesser grade SAHs. It is a biological process unrelated to the demands of an HMO. January 21st, the day these vaso-spasms are supposed to subside, is the day Maxicare wants to move my wife from an advanced tertiary facility to another facility wholly unfamiliar with her exact condition and corresponding medical requirements.

Vaso-spasms are a critical life threatening body reaction to certain types of brain injury. Physicians use Doppler monitoring to observe their advent and decline. They can occur at any time during and after this twenty-one day period. They are of critical concern for at least two reasons. If uncontrolled, they can cause damaging strokes to the brain. Their treatment, a matter of containment, is risky to the patient, requiring the extreme elevation of blood pressure in an already injured brain and the moving of the patient from neuro-surgery to the cardiovascular section.

Armed with this medical knowledge, one can readily understand the essence of time to this patient and her retention significantly longer at UCLA, and thus how, the plan's carrier, Maxicare of California, Inc., failed to provide continuity of care as promised to the families and citizens of the State of California per 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.

It also demonstrates a real lack of concern for this patient. It is one thing to lose track of a patient with a broken finger, but to lose track of a patient of such serious magnitude injury for two days is unconscionable.

It seems to me that either the DOC's response completely disregarded information presented by me to them, or that they somehow construed California Code to specifically allow the disruption of one extremely critical patient's ongoing care and essential medical treatment, so that the Health Plan under investigation would be found in compliance with the Knox-Keene Act.

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"!

I believe that it was overlooked by the DOCs investigators because of its vagueness.

It might be my failure to provide the DOC with interpretations of these chronicles as well as others, which led to the case's out-of-hand dismissal. However, I do believe that if the DOCs investigators required clarification or explanation of the brief and factual diary I maintained, they should have asked. I'm sure at times, that the DOC sometimes requires explanations of patient records provided by doctors and hospitals. At the time, I believed that it was my responsibility to provide the DOC with evidence, not an explanation.

This very short passage tells about how Maxicare of California, Inc. phoned Prairie Group, the assigned Provider, and told them that because they are going out of business in the State of California, this patient will no longer be covered retroactively to April 1st, two weeks before they told anyone.

If such was the case, then Maxicare of California, Inc., is in violation of 1367 g, that medical decisions by qualified medical providers are not administrative nor fiscal.

What makes this particularly troubling is that the DOC seems to refuse to recognize, acknowledge and respond to this unbelievable and significant allegation concerning an ailing carrier, who once before, not more than a decade ago, did the same thing right under the DOC's nose

Such persistence of the omission of action by the government, particularly in light of our present Democratic governor's coziness with big business in establishing a central committee regarding HMO regulation, indicates to me that the Knox-Keene Act will not be enforced.

This also speciously refutes the DOC's denial letter based on insufficient evidence, since two of my own business clients can independently attest to Maxicare's alleged withdrawal from the health care field at that time.

It should be noted that this letter, dated September 2, 1997, shortly follows on the coattails of a July 23rd MRI finally scheduled by Maxicare of California, Inc., after more than six months absence of radiology testing. This was the first MRI authorized by them, and in my opinion not done on the patient's behalf, but as a defensive action, no doubt, presumably designed to appease the DOC's investigation and coincident moratorium.

Compared to UCLA, prior to Maxicare's assumption of their control over my wife's treatment and care, she was receiving numerous daily scans. Once she was forced out of UCLA, which was one of four tertiary hospitals worldwide familiar with my wife's surgical procedures, routine and essential scanning ceased. In fact, Maxicare's contracted hospital, Freeman Memorial, was so unfamiliar with GDCs, that they were uncertain if to proceed with this one and only MRI at their facility. They were concerned that the powerful super conductive magnetic field, which is always turned on, might dislodge her coil. I explained to the radiologist that the coil is made from a noble metal, platinum, and is not ferrous.

It should be noted, under California Code, basic health services per (b) of Section 1345 (3) specify ongoing radiology, which no doubt, by intent, is inclusive of MRIs.

Also within Section 1345 (b), as specified under those Standards set forth in 1367, i, 4, though my wife's plan included Home Health, none of her carriers honored those benefits as the plan move originally between Aetna, Maxicare, CareAmerica and Blue Shield. To this day, though she is eligible and has amassed more than two hundred and forty days of nursing care, the plan has not provided a single nurse for more than one hour throughout the two years she has been home!

This neglect to the patient was implemented by the sudden and unexpected dismissal of Maxicare's outpatient nurse during the preparation for home care and nurse's training and has been fully documented in materials given to the DOC, again representing the unfortunate absence of State intervention and enforcement per 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.

Recently, Department of Corporations personnel, namely Melissa Moon, Helen --------, ____________ _________ and ___________Woods have resolved the dispute over FiberSource nutrition with CareAmerica. A case was delivered yesterday, so we haven't run out. Again, I thank them for all their efforts put forth. Thank you so much.

Helen ------------ spent over an hour on the phone last week, calling from her home, explaining how the carrier's benefits for an employee plan, expire when certain conditions are met, such as the final expiration of COBRA and the parent company going out of business. Though I acquiesce to the DOC's ruling in this regard, one can only question the meaning of the phrase "unlimited benefit coverage" if in fact, such benefit coverage is NOT unlimited. Does this not fly smack in the face of Knox-Keene Act regulations concerning advertising, solicitation and evidence of coverage accurately disclosing benefit expectations?

Another example of cutting hairs, is my wife's bed.

Prior to her dismissal to home care, I learned a lot about hospital beds. There are highly specialized beds, some costing as much as $120,000. But, in asking her respective PCPs under her plan, none would make any recommendation, asking instead, what I might have in mind. Eventually, when it was time for her to have a bed, she got what was called a fully motorized bed, despite missing some critical functions.

No doubt I signed all the delivery papers concerning this bed, which CareAmerica has misconstrued in saying that the family is delighted in its delivery. I even bet you have a paper in your keeping mentioning this in order to assure the DOC that our family is delighted with the outcome of this matter.

Now, besides missing certain critical functions and having a bamboo pole I erected as its IV pole, and the first bed leaning to one side, dropping ball bearings on the floor, making a lot of grinding noises, once or twice collapsing, cutting my pants legs as I snag them onto its sharp metal edges and hardly being specified by any physician in its design and purpose, it seems to have passed the DOC's inspection with flying colors. How did this happen?

The original outpatient specialist assigned by Maxicare told me that she would make sure that Buc got the right bed as a durable good covered benefit. She said that there are sand beds, air beds, beds that rotate, all kinds of beds to alleviate the possibility of bed sores as well as other physiological and mental problems associated with patients confined for inordinately long periods to their beds without moving. What we got was basically equivalent a 1945 WWII military bed for those with temporary medical conditions, not permanent confinement.

As time progressed, we began to receive rental charges for the bed which came to more than $8,000. Eventually the DOC discovered this, and came to bear on the respective providers, thanks to Melissa Moon. I was hoping by now that the DOC would recognize that my wife was sleeping on not much more than a motorized straw mattress, a bed type clearly defined by the Knox-Keene Act as being unacceptable.

However, all of this began to be swept under the carpet with apology letters from Blue Shield and the bed provider, Apria Home Health, rescinding all charges, whilst in the process of making a deal with each other. On several instances letters referred to the bed as being fully motorized, which it is not. It is a far cry from the many possible and very appropriate beds for this patient. But, I have given up as one more time, the DOC has failed to enforce the true spirit of the provisions of the Knox-Keene Act.

I have drawn your attention to these several examples in the one last hope that you might reopen Constance's RFA so that she may receive her rightful benefits she desperately needs in order to recover.

I pray is there please not something you might still do for this poor woman, where without your protection, she will yet surely die?

Yours in trust,

Joel Webb on behalf of Constance A. Webb

copies to:
Secretary Dean R. Dunphy - Business, Transportation and Housing Agency
Senator Tom Hayden
Commissioner Chuck Quackenbush, Department of Insurance
Senator Barbara Boxer
Senator Dianne Feinstein
Representative Henry A. Waxman
Representative Sheila James Kuehl
Governor Gray Davis

File: DOCRFA7478