Ms. Melissa Moon
Corporations Counsel
State of California,
Department of Corporations
Health Plan Division
320 West 4th Street, Suite 750
Los Angeles, CA 90013-3001
(213) 576-7500
Dear Ms. Moon:
I am now in receipt of your most recent letter (May 25, 1999).
I wanted to get my letter off to you sooner, but I seem to have very little
time and I am greatly exhausted from this ordeal. Presently I have
three nurses taking care of my wife: a day nurse in part paid by
Federal money, issued by the Kathleen O'Connell, the State Controller,
and administered by the County of Los Angeles through their In-Home Supportive
Service program (IHSS). After an administrative judge ruled that
since my wife is unable to move or speak, she is now receiving full benefits
amounting to 283 hours monthly, which comes to $1627 minus my share of
$340. Unfortunately, they do not see her qualifying for maximum benefits
allowed for spinal cord injury patients which exceeds 700 hours monthly,
even though her incapacitation is identical. Also, they view me as
an available spouse, to take care of her at night, without concern that
I work all day long and that when I take over her care, I am essentially
starting another fourteen hour shift. All in all, it is insufficient
funding for such a unique patient. This has been going on since October
of 1997, when Maxicare no longer felt obliged to continue coverage, which
their Summary of Benefits claimed to be unlimited.
So unique is my wife's condition, that in December of 1996, only thirty-three
patients of her class of Hunt & Hess grade V Subarachnoid hemorrhage
(SAH) were in existence, and only four hospitals worldwide performed this
surgery. Of these patients, UCLA Neurosurgery informed me that despite
my wife being one of the worst, seven of the other patients had died subsequent
to their surgery.
As you know, one of the Maxicare physicians branded my wife as chronic
vegetative, against my protests. Her medical records clearly indicated
that the site of her injury occurred low in the basil tip, sparing her
cerebrum from the ravage of blood inundating her lower brain areas.
Recent evaluation1 by another physician refutes this earlier false prognosis.
It would be impossible to go into all details of what has happened
to this patient and her family, I am merely trying to give you a general
overview history.
Without supporting evidence, I can only tell you that a broad
and persistent pattern unfolded, as a common behavior of numerous professionals
associated with Maxicare's stewardship of my wife's plan, clearly demonstrating
omission of action and perhaps suggesting willful abandonment. Many
of these I have summarized as follows:
1. Failure in recognizing the necessity of keeping my wife longer at
the appropriate institution familiar with my wife's condition (UCLA) and
quickly moving her to another institution (Freeman) wholly unfamiliar with
this type condition.
2. Numerous physicians and specialists affiliated to her plan's carrier
intimating to me the hopelessness of her case. There is the question
of a medical conspiracy by her MAXPHYSICIANS to essentially set in motion
abandonment proceedings.2
3. Numerous physicians and specialists affiliated to her plan's carrier
intimating their professional knowledge of such and exaggerating the number
of patients they and their institutions have provided medical assistance
for this same class injury. Essentially, none of them had ever had
a single patient of this order of injury.
4. Disinterest by her primary care physician in pursuing an aggressive
or optimistic course of action.
5. Disinterest by her neurologist in her case.
6. Failure to provide expensive test and evaluation commensurate to
those conducted by UCLA. (I know firsthand of patients at UCLA with
the same injury, but of lesser grade who continued to receive evaluation
and testing, virtually omitted for my wife once she was removed from UCLA.)
7. Refusal to accept me as her advocate, leaving her, as a brain
injury patient unable to move or speak, defenseless against the omission
of treatment and post-surgicial care, and potential abandonment proceedings.
8. A phone mail system at both the Providers headquarters (Prairie
Group) and at Maxicare's administrative offices, which was often impossible
to penetrate, time consuming and frustrating. It should be noted
that Linda Azzolina3 told me to keep careful records of this, as they were
important to the DOC, but which were later apparently rejected by the DOC
as being of insufficient evidence. Because of Joe Parra's4 comments
one day on the telephone to me, that "it is not that we (the DOC)
don't believe you Mr. Webb...", I suspect that the DOC has continually
viewed me as a histrionic spouse, whereas they have viewed Maxicare as
an upstanding and professional group of administrators who would neither
alter, shred nor misplace patient records, nor possess true financial concern
over the matter. Currently, it sickens me to think that Maxicare's
former Chief Financial Officer, Eugene Froelich, is employed by the DOC
as a conservator. I can't imagine how many clandestine phone calls
and meetings must have occurred between the DOC and Froelich, and other
Maxicare administrators during my wife's RFA investigative proceedings,
in order to iron things out.
9. Complete omission of treatment commensurate to my wife's original
injury during a period of quarantine against hospital induced diseases
(spinal staph, pneumonia and VRE) during her entire stay at Freeman, during
which time comprehensive neurological evaluation was impractical and dangerous
to others. I can only note that during her entire stay at Freeman,
I had never seen any neurological examination going on, ever, nor reports
nor comments to the same. However, I do believe that the $48,000
price tag on her care during her Freeman stay, was inaccurately presented
to the DOC by Maxicare as being represented of care directly related to
her brain injury, which is not the case. All care at Freeman was
for damage control for these potential fatal diseases acquired post surgically
at UCLA because of extremely unsanitary conditions in ICU West.
10. Neurological testing leading to an inaccurate prognosis
while my wife was deeply embedded in coma and heavily medicated, during
which time she was twice returned to ICU because of nursing oversight leading
to critical dehydration. (several nurses told me it was wrong to
expect any patient under these conditions to respond favorably to such
neurological examination). These events were so serious, that her
case worker affiliated with Freeman Hospital called for an unsolicited
nurses meeting which I was asked to attend.
11. Despite the suggestion by her then acting internist, Michael
J. Lieber, stating that "She was a reasonable candidate5 for acute care
just down the hallway." as he pointed in that direction, within a week,
she was removed to an Outpatient Facility thirty miles away! Because
of this action, there is the plausible notion that because of the family's
trauma and because many families under these circumstances tend to lose
hope for their loved ones, removing the patient to a distant contracted
facility might induce the family to abandon their support. In light
of this, it should be noted that Maxicare had many skilled-nursing facilities
within a short distance of the family's home, which was not in Lomita,
but in Santa Monica, thirty miles up the coastline.
12. The rotation of assigned internist, as with case workers,
just when lines of communication, rapport and understanding were developing.
13. The deft manipulation of her PCP in preventing choices
for appropriate, and hence more costly care. One choice was Brotman
Medical Center in Culver City, after he told me that Freeman acute care
(down the hall from her room) couldn't accept her. The next day he
informed me that Brotman couldn't accept her because she was diseased.
Oddly, the only other choice he allowed was the skilled-nursing facility,
Casa Colina, thirty miles away in Lomita. Equally strange, within
a week after her arrival there, her room was no longer quarantined, despite
her stool coming back positive for VRE, He never made mention of
any contracted facilities close to our home in Santa Monica as alternative
provider choices.
14. The failure to abide to State regulations concerning
HMO grievance procedures and internal regulations of Maxicare, to provide
alternative specialists within sixty days, if communications break down
between patient and physician. In this specific case, after undue
duress and dismay, it took me seven days to reach her PCP to place this
grievance before him, whereupon the following day, her neurologist assigned
by Maxicare called me on the phone, presumably through the PCP's prodding.
His conversation went like this. "Mr. Webb, though I haven't had
a chance to review your wife's charts and records, but she will be chronic
vegetative and permanently disabled." That was more than three weeks
since she was first admitted to Freeman. Apparently, in their view,
that was sufficient in reestablishment of communication, as it also appears
to be to the DOC under the Knox-Keene Act. I remember that day very
well, when he told me this, my knees buckled, and I never forgot his words,
though he was dead wrong.
I believe that this was Maxicare's orchestrated attempt via their Provider
to avoid reassignment of specialists by spiriting my wife out of Freeman.
Since at this time, I was terrified of Dr. Chew, and thus under duress,
I could only agree with the PCP's recommendations. It should be noted,
that in our conversations at this time, he said that my wife no longer
needed the services of a neurologist, which is also apparently acceptable
to the DOC as well.
15. Knowing the dismay, confusion and disarray of the family members,
who during the day were more able to frequent their sister's room, since
I was working, Dr. Chew impose distrust between us, telling her sisters
that it was I who was not communicating. If he was referring to the
chance encounter between us, when he dropped her sore arm which was inundated
from IV medications, to see if she might react, and then suddenly thrust
his two fingers towards her eyes in her darkened room to see if she might
blink, telling me that she has no threat response, then he is right.
I was dismayed to observe his examination procedures under these circumstances,
protesting that he should be more gentle with her, and I was hardly in
agreement nor impressed by his investigative techniques.
Later, I tried his techniques at home, in broad daylight, with one
of her sisters, she did not blink. I've tried it with business associates,
they did not blink. In fact, quite contrary to Dr. Chew's findings,
in my wife's darkened room at Freeman, when I would go to wipe her forehead
with a tissue, she reacted every time. She could see it coming, but
not Dr. Chew's skinny little fingers. It was an unfair test!
Which brings us to something else.
16. Very early on, at UCLA, one of the neurosurgeons conducting family
meetings told us that my wife had 100% irreparable brain stem damage on
the right side, and 75% irreparable damage on the left. More than
a month later, in her room at Freeman with Dr. Chew, I asked him about
this. He told me, barking indignantly, that there was nothing wrong
with her brain stem! The social worker confirmed this, stating that
she had seen this written in his notes. I feel that this was significant
progress for this patient, yet he reported it to no one. Much later,
after the patient had been released from Freeman, I gathered her records.
Strangely, they were absent of any neurological report, and in particular,
this recorded improvement of the patient during her stay at Freeman.
There is no question in my mind that Dr. Chew was hiding things, by not
telling his superiors. After all, he was working under capitation,
and subject to review. Whether or not their was collusion and conspiracy
is beyond me, but considering the severity of such action, even though
only potential, in respect to the well being of another defenseless human
being at the expense of engaging in business, should hardly require immutable
proof under any system of justice or regulatory action.
17. From the onset, in December of 1996, Maxicare was under
financial distress6 and no doubt their fiscal closure at the end of the
year was rocked by an unexpected entrance of a new patient three days before
her COBRA would expire, whose expenses could top ½ million dollars,
providing the patient was given adequate care. There is no question,
they wanted to bail out, clearly marked by their attempts to defraud this
patient by telling their contracted Providers that she was no longer covered
because they had terminated her group plan.
On May 14th 1997, they informed Prairie Group of this, who in turn
told Casa Colina's administrators of the same, who called me to inform
me that she could no longer stay there. Unbelievably, this scheme
was made retroactive to April 1, 1997! From then on, my wife's care
became attenuated.
So distressful was her situation, she gnashed out four lower incisors
and swallowed them. I can only thank the wonderful Dorothy Oda of
the DOC's emergency division in saving her. But why did the DOC stop
there? Was it not apparent to the DOC what was going on?
In July of 1997, under the DOC's moratorium, Maxicare elected to conduct
their first MRI of this patient. Again they chose secrecy, neither
the PCP or internist informing me of this, scheduling the MRI thirty miles
away. Only because I had developed a good rapport with the nurses
did I find this out, and was therefor able to assist in the MRI proceedings.
What I saw was of importance, the original site of her SAH being greatly
diminished, indicating its reabsorption.
What Maxicare reported to the DOC, made no mention of this improvement,
but rather chose to claim the patient was devoid of hydrocephalous, and
thus required no further attention under the plan. Again, it seems
not the well-being of the patient their aim, but rather a means to escape
from their responsibility to the patient.
I would not go so far to say that there was some sort of collusion
between the DOC and Maxicare, but one must ask the question, why the DOC's
independent counsel, as a medical expert, chose not to pursue the full
ramifications of this MRI evaluation, limiting instead the scope of inquiry
and interest only to the question of water-on-the-brain, rather than profound
improvement of a patient's condition overall, which was readily apparent
for all to see.
I believe that if there was comprehensive interest in the patient,
any independent counsel would have sought out the wide ranging implications
of such long overdue and expensive testing as not only being supportive
of the defensive posture of Maxicare in conducting this test in the first
place, but as being supportive of the patient's needs as well. That
obviously did not happen, and it is something that the provisions of the
Knox-Keene Act fail to address.
18. Shortly after the moratorium against Maxicare was lifted
by the DOC, Maxicare offered me nurses training, in the event the patient
was brought home. Several professionals in the field told me that
this was an unprecedented action on their part. Maxicare also assigned
an outpatient case worker to assist in the now urgent details of preparing
the home for the patient's arrival, as well as providing advocacy in all
aspects of the patient's transition from Casa Colina. After considerable
trust and rapport developed between myself and this particular case worker,
who on the phone from Maxicare's offices, told me that she would assure
that this patient receive all the benefits due her, inclusive of durable
goods (bed and wheelchair) as well as in-home professional services, she
was suddenly removed from the case, unexpectedly and without reason.
This was only one week before my wife was scheduled to arrive home.
I believe that during our conversations, her phone was being quality monitored
by her supervisors. I never spoke to her again! I remember
my last request was if they were going to send a nurse to evaluate the
home conditions, in order that it might serve as a semiskilled nursing
facility.
As consequence of her sudden departure, I was caused great grief, dismay
and disarray, and many of the things she told me that my wife should receive,
subsequently were never honored.
19. The sudden and unexpected assignment of new case workers under
stressful, urgent and critical conditions, who were unfamiliar with the
case and who lacked good command of the English language and hence communication
skills, caused stress, confusion and ill preparedness. To me, this
is not a case worker. A case worker is one who stays with cases until
their conclusion and is so familiar with the patient, that they are ready
and able to handle sudden contingencies, in contrast to a specialist who
comes in on a case only when such special skills are required.
Currently within the DOC, there are several open Requests for Assistance
(RFAs) and Call Identification Numbers. Of these, the only one formally
activated by me was sent by messenger to the DOC on 3/10/99. This
is against CareAmerica Southern California, Inc., for potential abandonment7.
It does not concern itself with her bed, wheelchair, feeding tube and referrals
to specialist, as you have indicated in your most recent letter.
All others should be held in abeyance by you (including your fourth whitewash
of RFA# 7478) until this RFA is resolved, since in its resolution, some
of the other grievances might find themselves resolved as well. Also,
it has been my experience not to put too much on the table at the same
time, since the DOC has already shown the proclivity to sweep everything
aside per insufficient evidence, by secret and independent counsel.
The DOC has also overtly demonstrated confusion because of the numerous
RFAs opened by them. Perhaps this was done to cloud the overriding
issue of abandonment.
At the time of its initiation, CareAmerica was reflecting the same
action as Maxicare, but in a different way. Instead of outright refusal
to act and denial of services, CareAmerica graciously acknowledged these
problems and even established a DOC liaison. Initially, I was surprised
to experience such a reversal in attitude, but soon found that it was merely
disingenuous lip-services no doubt orchestrated to fall short of providing
tangible results, since these efforts shortly preceded the plan's termination
as the patient's COBRA expired. It was nothing more than a foot race
and the continuation of patient abandonment, which I was hoping the DOC
would quickly recognize and act to prevent, in which one of the participants,
CareAmerica, would never need to finish, and hence, find themselves accountable.
Instead, the DOC's paperwork and procedures led to confusion and inaction,
allowing CareAmerica to execute its option of abandonment. After all, if
her coverage expired, how could anyone accuse them of abandonment?
It would not seem to be their fault, though bear in mind, that this patient
was considered to be a short timer.
20. Spring 1998, CareAmerica's newly assigned PCP, David Cutler,
in a brief fifteen minute examination seemed primed to offer little professional
advice, his first words being, "What do you want to do?" Then, without
really knowing the patient's full circumstance, and in front of the patient,
who, contrary to his opinion, understood all that he was saying, commented
that she would not get any better.
We shuddered in disbelief
that he would say such a thing, my our nurse, standing in the corner of
his small examination room, put her head down.
He was treating my wife as though she was chronic vegetative,
as though she understood nothing, dashing her hope of recovery and the
promise of good medical care, in a fifteen minute interview. He also
proceeded to provide us with his medical knowledge which was wholly inconsistent
to the true nature of her injury.
21. Remarkably,
when CareAmerica took over the plan in April of 1998, the patient's original
surgeons and neurological providers at UCLA, were under contract by CareAmerica,
yet her next PCP, Dr. Nagata, made little mention of this nor sought to
impose the urgency of taking advantage of this important change of venue
concerning the patient's well being and care.
Wouldn't that have been advantageous for her to be seen by her
original specialist?
Thus, is not the denial of continuity of care, which was almost
automatic to the patient, and which would have cost CareAmerica considerable
expense, nothing less than categorical abandonment based upon circumstantial
action and motive?
If you ask the PCP, he will say not, claiming that it was I who
didn't want to take her over to UCLA, which is true. But I was waiting
for a safe wheelchair for her, one which CareAmerica had promised, and
which never showed up until after I found out the Blue Shield had taken
over my wife's plan, and the UCLA was no longer listed as being under contract
to them. I could have cried when he told me this. Why didn't
he tell me sooner? Why did he not alert us to this possible change?
He knew that I would have found a some means to get her to UCLA, because
it was so important to the patient. Apparently. as her third PCP
and the second one under CareAmerica, he felt no obligation to provide
her with attainable, aggressive treatment.
21. Numerous phone calls, conversations and letters concerning
the patient's bed, wheelchair and neurological testing between myself,
Blue Shield, CareAmerica and the DOC, leading nowhere, until eventually
now, when it is too late to provide, or even make recommendation of, specialists
and testing, she is allowed to see Dr. Kudrow. This is March
17, 1999. Her last MRI was July 23rd of 1997.
If one sees abandonment as a heinous and singular act, then there is no case. If on the other hand, the act of abandonment occurs over an extended period, following a vague pattern of incidental omission, is it not the same? Of course it is, because the intent can be the same, though the actions obscure and within acceptable legal, political, administrative and medical parameters.
At what point do the regulators see the defect in independent and expert
testimony at all levels, of which they depend?
What does it mean to them when one of the plan's specialist indicates
that the patient will not get better, as the patient is being ejected from
coverage, and yet later, other specialists follow a seemingly progressive
and optimistic course, recommending the acceleration of the patient out
of long-term therapy into short-term outpatient recovery, in order that
she receive aggressive physical and speech therapies, only to later say
that the patient was not receiving any benefit at all from such therapies
(which were ironically discontinued concurrent to the plan's carrier's
attempt to bail out), without significantly modifying the earlier prognosis,
that the patient would forever be chronic vegetative and permanently disabled?
How do the regulators reconcile this with the unsupported and insufficient
belief by the patient's spouse, who cried that it is too early to tell,
especially when the patients initial surgeons implied that directly after
surgery, in light of the extreme trauma of her injury, that it was also
too soon to tell?
At what point do these regulators deem it not to be too soon to tell?
At two months, six months or eighteen months? Or when the patient
is ravage by disease and quarantined and isolated in a darkened room, as
was the case, when Maxicare's PCP deemed that she no longer required a
neurological support and healing?
How do the regulators reconcile this with the unsupported and insufficient
belief by the PCP, who stated that in the patient's interest, it would
be better for her to go on to a more aggressive, physical therapy outpatient
facility, and one I might add, completely unfamiliar with this type and
class of injury?
Last year, a medical liaison and fellow at UCLA Neurosurgery called
to apologize for their losing track of this patient. He reiterated
the thirty-three patients of her group to me. They were grade V SAH
patients receiving GDC (Guglielmi Detachable Coils) surgery. She
was one of the worst, yet seven others had died. He also told me
that her window of opportunity recovering from coma was statistically more
than twenty-four months, and perhaps as long as thirty. Her window
will close this June, yet she has received no help from her plan, other
than for the original surgery for her injury. And that was quite
by accident, under medical emergency, without Maxicare's knowledge.
Unquestionably, as in the case of other families at UCLA, who had to
litigate hospitals for days with their plan's carrier, Buc would have died
under the same circumstances.
It was only fate, that the emergency ambulance driver knew exactly
where to go. And time, is of the essence. Thirty percent of
the patients die en route. By the time she reached UCLA, less than two
hours later, her surgeons were prepped, and within three hours of that,
she was entering major evacuative brain surgery for a massive SAH the size
of a baseball. Several hours later, about 1:30 AM, she went back
in for GDC surgery. This is where they spin a fine platinum wire
into the seat of the injury, patching her up, better than new!
Given this set of circumstances, had her HMO administrators deliberated
but for a few hours, she may have died. This how critical time can
be when it comes to victims of brain injury.
Dear Ms. Moon, I have written you this letter in the attempt to sort
out the several pending RFAs, as we talked about last week on the phone,
in the hope that the resolution of the only current, official, and pending
RFA based upon Call Identification Number 78570 and directed against CareAmerica
Southern California, Inc. and delivered to you by messenger on 3/10/99,
will be investigated. In the interim after our discussion, I was
surprised to receive your communiqué terminating abandonment investigation
against Maxicare, which I don't believe you told me was active or had discussed,
though I may have forgotten.
In any event, by doing this, you have made my current letter virtually
worthless, and I believe this is being done as a legal measure to bury
the support of "new" evidence. Basically it seems, that all the DOC
needs to do to get off a case, is to momentarily open it, or open another,
submit any communiqués to them, and then close them, whilst at the
same time avoiding the discussion of the focus, impact and details of the
RFA I institute. After all, neither you or anyone else at the DOC
has responded at all to the one Request For Assistance submitted to you
under Call Identification Number 78570 direct against CareAmerica for ongoing
abandonment.
Your letter continues then, attempting to assuage my feelings towards
the DOC's inaction by telling me that you might continue to pursue investigation
in a manner secret and internal to the DOC. You cite the Law as your
Cause, stating that your "internal deliberations" are not a matter of public
record.
You also go on to say that you might keep me informed. However,
I should note that over the course of several years, this has never been
done, where in fact, it is the HMO under investigation who informs me first
of your rulings. Apparently it is they who serve as your back-seat
drivers and who are privy to your internal deliberations, though it is
my wife who suffers, and though it is she you are suppose to represent
in initial purpose and cause.
Then, you go on to cite the informality of this review process, which
suggest that all of this has little substantial import in the licensing
and regulation of health plans, when in fact such regulation rest solely
and squarely in the DOC's lap. I believe that this statement of the
informality of the DOC's interest is merely a safety clause protecting
the State from the legal countermeasures of big business. When I
initiated the first RFA back in 1997 it was hardly an informal process
which I had first encountered, when I called the 1-800 Help Line.
I was grilled over the course of three days, before taken seriously.
By now, you must understand my dismay, but it does not stop here.
The entire first page of your letter dismissing RFA 7478 exclusively
focuses on the DOC's responsibility, not the details of the case of hand,
citing innumerable codes and regulations whose delineation's are not readily
available to me, being typical of all letters I have received, with the
condescending reminder that I may seek alternative remedies, notwithstanding
lawsuit, which you know is pragmatically impossible under Federal regulations
concerning HMOs, and the pursuit of the internal grievance procedures of
the HMO in point, the latter being the principle reason in my contacting
the DOC in the first place.
Then, without the slightest inquiry or concern regarding my RFA you
go on to other issues, which I had already explained to you on the phone,
were not nearly as important, and which otherwise might find resolution.
In closing, your letter suggest that I refer to the Evidence of Coverage.
In Maxicare's Summary of Benefits8, under BASIC HEALTH SERVICES, they promise
"Treatment of Illness or Injury". Pray tell then, how could a patient
of the most massive head trauma, with a twenty-four to thirty month recovery
window, receive this promised care, when no money was expended for such
a purpose, when the patient has been catapulted into Outpatient Status
in only three months and when only one MRI, and one or two c-scans have
been performed? I am not talking about a patient with a cough or
cold, but one with severe brain trauma resulting from injury of extreme
magnitude, in combination with very new and unprecedented surgery.
I believe that even the UCLA doctors were amazed that she was still alive
and doing well after fifteen months, which is hardly any excuse for anyone,
including a MAXPHYSICIAN who never looked at her charts and records, to
deny necessary and customary treatment, even if beyond the scope of your
apparently senseless Knox-Keene guidelines.
In the same Maxicare Benefit Summary, under the category of "Treatment
of Illness or Injury", for only a $5 co-payment, a MAXPHYSICIAN will visit
the patient's home. During the course of this patient's recovery
period, she has had only three home visits in one and a half years.
This was concurrent of the plan's change of carriers. Also, they mention
Laboratory and X-rays Procedures requiring no co-payment, yet for even
a greater period of time, since she was at Freeman, she has received only
a few x-rays and only one MRI; the one MRI ostensibly not for the
patient's benefit, but rather for Maxicare's benefit; designed to extricate
them from beneath the DOC's moratorium.
They even list CT scans under their summary provisions.
Presumably the patient must be deceased before the MAXPHYSICIAN orders
it, or perhaps it is the opinion of their Utilization Review (UR) panel,
that serious brain injury patients, who in their view, have very little
chance of recovery, don't deserve them. Didn't any of you ask why
this patient received none? Isn't massive head injury postoperative
recovery and healing a good period of time for this type of laboratory
testing? What did your little legal beagles do when they reviewed
the materials concerning my wife's case, which I had sent to them more
than a year and a half ago? Did they throw them away? And what
about your secret counsel, who behind closed doors, sealed my wife's fate?
Hopefully, it was not Eugene Froelich.
And what about all the materials since? What happened to the
very first grievance documents sent to you in the first instance in 1997?9
How could your secret counsel have ruled them as insufficient, and even
more important, why?
Why does your Chief Administrative Officer, who by law must inform
me of the location and internal use of such materials, never respond.10
How is it possible that hundreds of pages of documents can be declared
as insufficient, or perhaps, even lost? Why is it, that you continue
to ask for more medical records, when under the condition of abandonment,
the only records are kept at home? Are you looking for some miracle
to prove that you have done a good job?
After experiencing this debacle of government in action, where already
elected officials at the State level claim my wife's case to be most likely
a Federal matter, and those at the Federal level, claim it to be a State
matter, I cannot escape thinking about how badly governments throughout
this world, treat their own citizens.
In Aleksandr Solzhenitsyn's book, The Gulag Archipelago, he talks about
the actions of the state against the people. In one of his stories,
an appeals trial of one of the many political prisoners under Stalin's
regime, an eye witness, once against this prisoner, totally recants his
prior testimony, thus freeing the accused. Since a ruling in favor
of the prisoner would be wholly unacceptable to the government at the time,
the trial concludes as the judge and prosecutors leave the courtroom without
ruling, remaining thus, the prisoner in jail.
For a democracy to cite or enforce the law in a manner which denies
public forum, which makes unaccountable promises, whose actions, though
for the public good, are not given to public record, and whose internal
deliberations are kept secret from many of its citizens, is no less, in
means, the same as the Communism underneath Stalin, and exactly in means,
identical to the overt behavior of the Department of Corporations, within
the State of California's Business, Transportation and Housing Agency.
In light of the response of the DOC's response to my wife's plight,
your are correct in suggesting that I seek alternative "dispute resolution
processes", rather what the DOC is unable to do because of the restrictions
and impositions of the law intruding into the field of medicine, which
achieve nothing more than the prolonging of suffering and the persistence
of the act of abandonment in a Society priding itself in its social cause
and advanced medicine, and of course, because of the DOC's perceived limited
scope of involvement and inconsistent and fickle response to the issues
at hand11, and in general, the proclivity of our government not to abide
to the traditional tenets of democracy outside the political arena, where
its actions are unaccountable.
Arising from all of this, is the specter that my wife is treated no
differently in the end, than that political prisoner in Communist Russia,
and that the State can and will dismiss any evidence or testimony out of
hand, and make any rules convenient and advantageous to them, denying its
Citizens, even the gravest of ill, promises once made.
But what is truly even more shameful than that, is that the State of
California, finds in their view, sincere cause to stand in the path of
this mute and paralyzed woman's chance of healing. Equally shameful
and wholly untenable in a logical and compassionate society, is that it
finds greater value and good in the support and enforcement in rules, charters
and regulations (such as the Knox-Keene Act), which are incomplete in their
scope and limited at best, at the expense of, in this case, one sick woman.
Oh! Miss Moon. About the bed. It still has an old
bamboo pole in place of an IV stand. But that is hardly of any real
concern! Its been that way since before Maxicare's delegation of
officers and doctors came to our home more than a year ago, presumably
at the DOC's urging. A lot of good that did.
The last escapade Maxicare indulged themselves, as a final insult to
the patient, was to pretend that they were paying for my wife's food source,
when in fact, when she was home, I paid C.O.D. on every delivery of her
250 ml cans of FiberSource. They (Maxicare) however were being billed
for my deliveries, though not paying for them. I found this out one
day, when their supplier, Professional Home Health, informed me that I
had fallen behind on my account with them. The lady on the phone
ran through the billing record with me. I paid $219, then Maxicare
was billed but had not paid $219. Then their accounting showed that
I paid $219 and that Maxicare had not paid their $219. This she said,
went on for several months. When I asked her for a hard copy of my
account, she never sent it to me.
Three weeks later, after I had heard nothing more, I called her.
She told me that they were working on it right now and would credit me
for about one-thousand dollars; after that, the prescription would
run out on April 1, 1998.
I asked her if she did not think it strange to discontinue an essential
food prescription even though the patient was alive. She agreed,
I told me that they will work on that. I've never yet received a
complete accounting. I never understood how Maxicare knew anything
about who I was ordering this food from, nor how much or when. But
it can be safely assumed that they were double dipping in order to show
government regulators the inordinate costs associated with the health care
business. It was their final insult, both Professional Home Health
and Maxicare, to pretend that more food was being delivered than actually
was, and that Maxicare was paying for it, when in the end, it would have
been us paying for Maxicare's share. They never gave a damn about
this girl.
Respectfully yours,
__________________________________
Joel E. Webb - Conservator
910-B 20th Street,
Santa Monica, CA 90403
copies to:
Acting Commissioner William Kenefick, Department of Corporations, State
of California
Mr. Brian A. Thompson, Chief Deputy Commissioner, Department of Corporations
Ms. Francine Woods, Department of Corporations, Ombudsperson
Governor Gray Davis
U.S. Senator Barbara Boxer
U.S. Senator Dianne Feinstein
U.S. Representative Henry A. Waxman
State Senator Tom Hayden
Representative Sheila James Kuehl
Ms. Donna M. Campbell, Deputy Secretary and General Counsel, Business,
Transportation and Housing Agency