Health Care: The Sequel

I awoke with an attractive woman leaning over me checking my body, and for a moment I thought I was in heaven.

But then I realized I had an oxygen mask over my face and an IV in my arm, which are not, one assumes, accouterments of the idyllic afterlife.

I was, in fact, not in heaven but in a recovery room of Encino-Tarzana Regional Medical Center, where, during that day and night, many individuals--both men and women--would ask to see my body.

It became so commonplace that I suspect some who made the request were either just curious passersby or hospital visitors who wanted to join in.

The reason the medical personnel were checking was to see if an incision near my groin was healing properly. It was made to facilitate a cardiac procedure known as electrophysiotherapy. To continue the analogy, it would be hell to lose me from a simple cut after all the noise I had made.

To those who just tuned in, I was hospitalized to undergo an EP to regulate my heart rate after passing out at Sears. I awoke cursing the HMO that was supposed to be looking out for me, in this case Cigna of California.

I had been trying for about 10 months to get the procedure approved through normal channels, but it took writing about it in this very space to finally light Cigna’s fire. One column accomplished what almost a year of anguish could not.

Anyone who has been unable to receive adequate treatment from their HMO should do this: get a column in a newspaper whose circulation tops 1 million and write about your agony. Then watch help come thundering at you.

*

I realize this is not a laughing matter. While I didn’t suffer a near-death experience with the tunnel and all, I was in some, you know, discomfort. Pain is not an option in a hospital. You don’t hurt, you just aren’t comfortable.

But at least I did make it to treatment. Could I have made it without whining aloud in a mass circulation daily? I suppose, eventually. But not soon enough.

HMOs cover 175 million Americans, 20 million of them in California. Cigna accounts for 13 million nationwide, 1.5 million in California. When a sprawling, moneymaking institution attempts to accommodate the health care of the wailing masses and still turn a nice profit, there are bound to be problems.

Cigna’s California media director, Jim Harris, apologized for my particular nightmare and assured me that it never should have happened. They’re looking into it. They should.

I hadn’t realized the extent of anger that exists toward HMOs until I received more than 300 e-mails on that single column. Victims of managed care’s failure, individual physicians and medical organizations are at war with the inadequacies that they feel have come to characterize HMOs.

Legislation already passed in California and looming in Washington to regulate these massive institutions is probably only the first shot fired. What may follow, given the passions of those fed up with the system, could turn the whole idea of managed care upside-backwards.

*

Jim Harris sent me a list of what a person can do if an HMO fails to provide adequate care. I had tried them all, short of filing a complaint with the state, and it still took a column to get treatment.

Once the article appeared, Cigna health care manager Susan Riccardi was on the phone, genuinely concerned and upset over the delays that had characterized my case. She guided me through the maze of referrals and authorizations with the swift efficiency of a combat colonel.

I got the procedure the next day.

A registered nurse for 37 years, Riccardi puts a human face on an institution that at times seems all too inhuman. “I care about people,” she says, and I believe her. But there are days, she adds, when there are so many needs that not all of them are immediately filled.

The problem is that there just aren’t enough Susan Riccardis to guide those with urgent needs through the system. “We’re real people here,” she tells me by way of defining her job. Perhaps more real people are needed.

I’ve been with Cigna probably 20 years. They haven’t made a lot of money on me. I go in every couple of years to have something patched, regulated or removed. Surgeons salivate when they see me walking by. Cigna has always come through.

I’ve heard the HMO horror stories. They only serve to emphasize that the system needs refining. Not everyone has a column to wave in its face.

Me? I’m not sure I’ve been made well. Tarzana is not Lourdes. I may need the procedure repeated. Not to worry. If I do, come by and check out my body. Everyone else does.

*

Al Martinez’s column appears with a little luck on Sundays and Wednesdays. He can be reached online at [email protected].