September 24, 1998 (Buc's Birthday)
Mr. Brian A. Thompson
Chief Deputy Commissioner
Department of Corporations
3700 Wilshire Blvd., #600
Los Angeles, CA 90010-3001
Dear Commissioner Thompson:
On April 1, 1998, Senator Tom Hayden sent you a letter for you
to look more closely into my wife's RFA #7478. Her name is Constance
Webb. Apparently you did not do so. Rather instead, I received a
letter back from Melissa Moon, stating that they (the DOC) stands behind
their ruling, thus closing my wife's case, with their second whitewashing
based upon insufficient evidence. Pray tell, how can it be insufficient
evidence if the case was opened by the DOC themselves, without solicitation,
and if they based the reopening of her case upon new information?
Does the DOC in one moment see new information suddenly synonymous to insufficient
evidence? Moreover, where did they get this new information?
Who provided it? What did it concern?
When Joe Parra (the ombudsman assigned to her case) and I discussed
this reopening, he said to me no less than four times, "Mr. Webb, it's
not that we don't believe you...", I knew full well what was about to transpire.
When he denied to me that hospitals are known to remove, alter and shred
records, something explained to me by an attorney specializing in medical
malpractice, I knew that my wife's chances of a fair and impartial hearing
would be unlikely as the DOC would always find the opposition's words credible,
but not mine. Equally bad, the DOC placed the determination of my
wife's case in the hands of an independent counsel, without recourse of
rebuttal, and whose qualifications are unknown.
Almost a year ago last September, when the DOC closed the first
moratorium, I was notified of the ruling two weeks after Maxicare had already
announced it. I found this strange, since it was I who requested
assistance, not Maxicare. On the second time around, both Maxicare
and CareAmerica were tumbling in to take care of the matter; Maxicare
setting up an unprecedented in-home meeting to see the patient1 and CareAmerica
gushing with enthusiasm2. They seemed to know what was going on well
before I did. It was becoming evident to me that considerable behind-the-scenes
dealings were going on, and it was again becoming unfair. Though
supposedly all this was happening on the patient's behalf, I was never
informed about what this new information was and why it was proclaimed
insufficient, nor did I have the privilege of a DOC liaison as did CareAmerica,
in order to better represent the patient's interest, allowing the mutual
reciprocation of information and the recourse of rebuttal; especially
if those making these decisions lacked sound judgment based upon a comprehensive
understanding of these type patients.
In light of these limitations imposed by the DOC: the assumed
lack of credibility of my evidence in the face of official records in conjunction
of a faceless third party deciding my wife's fate, who may or may not be
informed of the advanced nature of medicine surrounding her inquiry, in
light of the fact that these limitations were never fully presented nor
explored by the DOC in advance, and in light of the fact that the DOC reopened
the case on their own, I therefore ask that I may be granted permission
to request the reopening of this case one more time.
If so granted, rather than presenting you with any information
which might be dismissed out-of-hand by independent counsel, I would like
to present the DOC with negative information pertaining to the absence
of care essential to this patient's recovery. Surely, if such uncertified
and unaccredited evidence so provided proves insufficient, it will be because
you have diligently proven otherwise. Under the circumstances and
limitations you have imposed in this regard, I think that this is fair,
especially, if you don't believe me all along.
Hopefully, this will reorient and enlighten the DOC examiners
as to the unique nature of my wife's condition, and to the profound implication
that much of her medical team was poorly informed by the director in charge,
her Primary Care Physician, Jeffrey Gramer. In the course of conversation
with many of these professionals directly involved with her care, they,
on several occasions, had commented as to the thousands of cases like hers.
At this time, I had acquired advanced information from Massachusetts General
Hospital, one of four facilities in the world conducting GDC procedures,
that there were less than forty patients of my wife's class, indicating
the inaccuracy of my wife's medical team's view, and even presumably of
your independent counsel. If so, and if your independent counsel
has dismissed this as being insufficient evidence, then I think that you
have every reason to reopen her case and for once demonstrate real accountability
towards this patient's plight.
As it has been documented, Constance Webb suffered a severe SAH
of Hunt and Hess classification grade V3 on December 28, 1996. Though
it was one of the largest experienced by the UCLA physicians and despite
its difficult location in the basil tip, they decided to pursue aggressive
procedures inclusive of evacuative surgery in the attempt to remove as
much blood as possible, followed by a very new type of surgical repair
called GDC4. Because both operations proved successful, and because
there appeared to be no vital brain destruction, poor brain stem function
or uncontrolled ICP, the patient was then committed to the twenty-one day
vigil for vasospasm inclusive of Triple-H therapy.
Shortly after her initial evacuative surgery, it was commented
that her brain remained spongy and during her twenty-one day period of
vasospasms, she suffered only one minor stroke.
In short, I believe you will find that Constance was a good candidate
for surgery with potentially a worthwhile outcome. Please don't take
my word for it, check with UCLA Neurosurgery and the MGH webpage, as to
how good her long-term outcome might have been with appropriate care.
Such care however, never commenced. Only two days after
the subsiding of vasospasms, she is yanked out of UCLA5 and placed in isolation
at Freeman Marina Hospital to be treated for two hospital induced diseases
at UCLA6, spinal staph and pneumonia, and acquiring a third deadly disease,
known as VRE while in isolation at Freeman7. This was January 23,
1997, less than a month after her surgery. I believe that it was
highly doubtful that her cerebral fluid was clear at this time and I am
not sure how long cerebral drainage (ventriculostomy) was continued at
Freeman, if at all. Your records should show this. It is critical,
as is the absence of medical transfer records8 during her move, which led
to the cessation of care for six hours or more. Your records should
also show that she received no MRIs, no c-scans, no testing, no task mapping,
no stimulation of senses9, no electronic muscle stimulation, no comprehensive
evaluation, no recognition of new surgical procedures and their outcome,
no specialized diet or medicine, no continuance of transcranial doppler
monitoring, no ventriculostomy plus the many other things her poor husband
knows not what, and if he did he would be afraid to tell10. Did you
know that at Freeman she was twice dehydrated (once dangerously) and returned
to ICU on both occasions and a nurse's meeting called in regard to the
poor care she was receiving? Other than Dr. Chew11, her MAXPHYSICIAN
assigned neurologist, who is now being sued for malpractice for refusing
to perform a spinal tap on a patient who died a week later from spinal
meningitis, there were, say, few specialists of this order, examining her.
Do you have records of her punctured lung at UCLA and that their physicians
didn't think she was as bad as they first thought? Do your
records indicate that at first her SAH was described as being as large
as a baseball, but later downgraded to the size of a golf ball by Dr. Vespa,
her UCLA EEG specialist? Are you aware that the greatest voiced concern
of the UCLA physicians was the possibility of irreparable brain stem injury12,
but that only two months later, Dr. Chew indicated that there was none
and yet otherwise concluded that Constance would be chronic vegetative?
Last night, she told me with her eyes that she could sometimes say the
word no and that her sisters say she is trying to talk. Do you have
his records? His neurological records were missing from my Freeman
patient records packet. I would very much like to know if he has
written, "no brain stem injury", as disclosed to me by someone who had
seen them as far back as March 1997.
On Tuesday March 4th, still in isolation and testing positive
for VRE she was moved into ninety day outpatient care at Casa Colina where
she was immediately removed from isolation status though still testing
positive for VRE, remaining potentially dangerous to their older patients
suffering from stroke and other head trauma who might have compromised
immune systems. If you knew this, did you tell the Los Angeles County
Health Department? Here she again received no treatment essential
to her class patient, being treated instead as an ordinary stroke/closed-head
trauma/gunshot injury patient ready to return to their home or to a sanitarium.
Do you believe me when I say that I requested her continuing
care at Freeman, which not only had an excellent transitional care unit,
the medically appropriate choice13, but was discharged anyway? Does
it concern you that Maxicare did not transfer her to the only appropriate
facility in the area, UCLA? Does it concern you that UCLA is a contracted
provider to her alternative HMO, CareAmerica, who refused to accept her
ongoing treatment for her injury over a year ago, claiming in to be preexistent,
despite CareAmerica being her employer's continuing health plan insurance
provider? Does it not concern you that in denying this patient's
appropriate and promised care under these health plans, as overseen by
the DOC, constitutes their abandonment of this patient and abdication of
responsibility to the citizens of the State of California as a whole, or
do you believe in theses cases that initial surgery constitutes the extent
of permissible coverage and that the families of these patients should
provide hundreds of thousands of dollars in treatment typical of such patients,
whose brains may not return to normal function for more than thirty months
after surgery? It is as well hard to believe that the DOC would expect
families of these patients to pay for all the durable equipment14 and machines
essential to the care of these patients.
No doubt this last statement, concerning the thirty-month healing
period, will be construed as invalid, even though it was reiterated to
me by a UCLA neurophysician not more than three weeks ago. And this is
the problem: the weighing of contradictory evidence between the professional
and the lay person as patient, and worse yet, the lay person as patient
advocate, especially one who might be deemed subject to spousal histrionics.
But, I don't deliberately misplace, shred and alter patient records, nor
confound everyone with intellectual gobbledegook such as hydrocephalus,
a condition which was not evaluated until July 23, 199715 by Maxicare,
a condition, which under aggressive post surgical management, should have
been pursued much earlier. So what is the test between us?
Why are my words disputed and discounted16 without recourse and despite
my representing the patient and asking for assistance on her behalf?
Is it because my words might damage the livelihood and reputation of business
professionals without legal sanction?
Let me give you an example. One morning at Casa Colina
my wife began to severely choke. Her face turned red, she put her
head down, drooled and gasped for air. I noticed that her remaining
lower front incisor was gone. I feared that she had just ripped it
loose and was choking on it. I looked out the door to the head nurse
and called for assistance. Admittedly, I was a bit panicked, so nurse
Rose just stared at me, refusing to get up to help. Eventually she
strolled in, disbelieving that my wife swallowed her tooth, and stood there
arguing while my wife was gasping for air, even though it was there the
night before, hanging by a thread. Rose was so determined that she
was right, she refused to even look through the bedding to see if she was
correct in thinking that Constance had not swallowed her tooth! When
I asked her to call Dr. Traughber to see if Constance might require x-ray
examination or otherwise, she refused. When I told her that I will call
him if she won't, she called.
Now, if Casa Colina's patient records showed no entry of this
incident, if its administrators denied the occurrence, as did Rose, who
would you tend to believe? If it was necessary for Casa Colina to
be closed down because of this incident or the firing of Rose, who would
you believe then? The answer is simple, you would believe the greater
consortium of professionals doing business. Even if I looked through
her bedding and all around underneath her bed and found no tooth, you would
still not believe me.
Would you believe me if I told you that about a month ago, my
wife told me that the reason she ripped out her teeth, was because she
was so often in distress at Casa Colina? On weekends, because the temporary
registry nurses, her entire wing would be hours behind schedule.
One Saturday morning I found her lying in a pool of urine with not a single
nurse, attendant or staff member in sight on her wing. More than
once I arrived to find her strapped to her wheelchair by Margarita, a nurses
assistant unqualified for such responsibility. Though I complained
on several occasions, you never knew what sadistic surprises Margarita
had in store for Constance: like twisting her headband so as to leave deep
imprints in her forehead or leaving the TV set turned on loud behind her
as she was strapped in her chair facing away from it. Onetime she
couldn't close her right eye because the headband was pulling up so severely
on her forehead.
I think that instinctively you would not act against these defendants
because your actions would carry great import and potentially devastating
affect towards them, unless of course, the information upon which you might
act, was certified, which would be impossible under our circumstance.
This brings us to the question as to who the Department of Corporations
represents under an RFA action, for indeed it seems, the RFA HOT LINE is
really nothing more than a guise and dead-end. I find this dreadful,
to broadcast17 that you represent the people of the State, when in fact,
under the most critical and contradictory situation, you don't. Here
you have this poor hapless soul unable to speak for herself, who worked
hard all her life paying taxes, who has received absolutely no care under
her HMOs for her original injury and was subject to debilitating, life
threatening and demeaning conditions, and whose present state will unquestionably
drive her family into poverty and despair, causing her spirit to finally
ebb and give way, because you and your attorneys are afraid to confront
big-business and the legal system on her husbands words alone. You
are all a shame for this.
Remember when over two-hundred years ago, when the Crown tried
Benjamin Franklin in London, which required his traveling in sailing vessel
for months across the Atlantic Ocean, as though it was a fair process?
Well, you're doing the same thing even now to the citizens of this State,
by pretending that they are fairly represented, though the denial of representation
is being done in a more subtle and different way, through the complex gerrymandering
of social services, by the unaccountability of social responsibility to
the People, and by the orchestrated denial of the small voices of ordinary
people as they face the antics of big-business in the field of medicine,
and all of it is legally sanctioned and mandated by their own government,
even in the moment of their greatest despair and need. If I may say
so, in my view, the DOC represents an unwilling keystone.
I hear the politicians talk of physician's rights and patient's
rights, but what good will it be, if we listen to only the physician, especially
if the physician is only an HMO hack?
So what does it take for you to believe me ombudsman Parra?
What is my test? Actually. there is none and there never should be
one. You should believe every patient, every family member of every
patient and every spouse of any patient who is unable to speak for them
self, as though they all speak the truth. But it takes courage to
do so, to face the onslaught of big-business and the rounds of attorneys
representing them, demanding legal accountability for any actions you might
take on behalf of any one, single patient, whose words you believe stand
without accreditation or certification against the challenge of the powerful.
You are engaged with the art and science of medicine; a
place where neither politics, big-business nor jurisprudence ought to prevail.
For if they do, those who have fallen victim to disease and injury will
be condemned to endure protracted pain, despair, agony and anguished as
these giant monoliths plod along their ponderable paths, in the futile
determination of the correspondence between profit and compassion, and
perhaps even, the measure of the human spirit, as we have come to know
the measure of the pints of blood in the human body and the invisible air
we breathe. It is a place where time is of essence, more so than
anywhere else, and it is a place where the dollar is meaningless to those
who are sick.
More than a year ago, I spoke with Dorothy Oda, a wonderfully
compassionate and understanding lady, who served as Chief Nurse Consultant
in the DOC's Emergency Division in Sacramento. I told her of my concern
about my wife's spirit, and how it could someday ebb from her body, as
though it were a colorless blood. Is that not reason to act now to
help, I asked her, or must the human spirit be something we can see and
measure before we act?
It seems, that the DOC has no provisions to evaluate the special
and urgent needs of specialized head trauma victims, and seems blind to
their unique condition, to the extent that their subsequent inaction might
result in mental degradation, thus causing a whole new set of illnesses
of which to contend. Does that not seem foolish? My wife is
not victim of a mental disorder, but a physiological injury, to which
a reversible mechanism of neurologic impairment can be identified, which,
if ignored, can cascade into a whole realm of mental illnesses with the
potential for disastrous and long term impairment. Thus, not only
do I call upon the DOC to find both HMOs guilty and culpable in the denial
and omission of care, but to find great urgency in this matter and act
now before any more harm is caused.
I should further add, that the contractual provisions in her
health plan include a ninety day sharing of home care annually, which comes
to approximately $20,000, has not been met by either HMO, nor even acknowledge
by them. Clearly your actions of denial has further emboldened their
refusal to honor their legal commitments and obligations to this patient,
who has already paid them in advance for this promised care.
Yours in Trust,
_____________________________
Joel E. Webb - Patient Advocate
_____________________________
Justin Webb - Patient Advocate
910-B 20th Street,
Santa Monica, CA 90403
(310) 829-0767 (home nurse) (310) 828-2292
(office)
copies to:
Senator Tom Hayden
23rd District
10951 W. Pico Blvd., Ste 202
Los Angeles, CA 90064
Representative Sheila James Kuehl
41st District
16130 Ventura Blvd., Ste 230
Encino, CA 91436
Governor Pete Wilson
300 S. Spring Street,
South Tower, Ste. 16701
Los Angeles, CA 90013
FOOTNOTES