A friend called a few days ago about an elderly friend to tell me of the trouble the woman was having in getting adequate medical care for her husband. The husband had had a badly infected toe for several days and the only appointment her husband could get in their HMO was with a nurse practitioner. Both my friend and I shuddered thinking how easily the man could lose his foot, his leg, or his life. Diabetes had not been a consideration, nor a staph resistant infection, or even a blood stream infection. Cultures should have been taken and lab tests done.
I thought back to a two-year-old with severe spinal muscular atrophy who did not have a pediatrician, but was being cared for by a nurse practitioner. The child had the lethal form of spinal atrophy and died a few weeks after I saw him. I was appalled that the little boy's care had been so bad. The parents were lovely people who simply didn't know how to fight the HMO and were overwhelmed by what was happening to their child.
My recommendation to my friend and to anyone who needs to fight for good medical care in an HMO is to insist that care must be given by a board-certified physician. To do this a patient may need to send a certified letter with a return receipt to the CEO of the HMO. He or she may be leaving all the decisions to clerks or nurses. In the letter I would state that you are willing to consult an attorney if you are not given the care you need. The mention of an attorney will most likely catch the CEO's attention and a qualified doctor or specialist will immediatly become available. It is sad that patients have to go to this extreme to get decent medical care, but no one should ever accept care by other than a board-certified physician. Your life may well be at stake if you do. One other resource is to find a patient advocate and a good resource is www.patientadvocate. org or www.patientadvocacy.org.
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