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Conversation
with
Kathleen O'Nan |
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HMO
Mergers
vs
My Mother and Me |
At the hospital, they call my mother the
Miracle Lady. In the past three years, she has been in the
hospital 25 times, including nine times in critical condition.
She has a chronic heart condition which is genetic, and
another genetic problem in her lungs. Three years ago she had
successful surgery for renal cancer, but now her other kidney
is overworked, and she has to go to kidney dialysis three
times a week. She’s 74 — a very old and frail 74.
My mom is a great patient. But it’s often to
her detriment, because she doesn’t complain when she should.
She does tell me the truth, and then I tell the doctors. She
also has short-term memory loss because of a stroke she had a
while back. So she often doesn’t know the answer to the
questions the doctors are asking. But because she wants to
please the nice doctors, she’ll unconsciously make up
something. And if the doctors don’t know her, they’ll
believe her, because she’s lucid. So I have to be there to
make sure she doesn’t end up with improper care.
Before she retired, my mother worked for
Orange County and belonged to an SEIU local. Through the
union, she had very good insurance, which she retained after
she retired. My mom’s HMO was one of the best in southern
California when she first joined it thirty years ago. But
since then, that HMO has been sold five times, and with each
sale there’s been an immediate degeneration of services.
FOR-PROFIT HEALTH
CARE
For instance, after one of the sales, they
shut their hospital and now my mom has to go to another
hospital which is contracted out. The new hospital doesn’t
have emergency-room services. So she has to go to another
hospital for urgent care. Recently, I had to take my mother to
five different places in one day. We go to one part of L.A. to
see her doctors for a regular office visit. But in that
building there’s only limited lab work; she has to go to a
place several miles away for her more complex lab work. If she
needs a prescription, she goes in another direction.
I remember when I first took my mom to the HMO’s
brand new hospital. At the entrance, there are those very
heavy plate-glass doors, but the doors have no electric eye
and have to be opened manually. As I was helping her into the
building, this guy came hobbling up on two crutches with his
own x-rays between his teeth, trying to open the door. And
inside, we found that there were more heavy doors separating
the corridor from each department. My mother and many other
people just could not open them. I think some bean-counting
administrator made decisions without thinking through people’s
needs, or really caring. It’s cutting corners. And this is
what happens constantly whenever one of these for-profit
health care institutions is sold.
WHO CARES?
After the third sale of my mom’s HMO, they
cut out podiatry. And podiatry for the elderly is very
important. My mother developed gout as a result of medicine
she was taking. But they didn’t catch it early enough
because they weren’t looking at her feet. My mother’s not
a complainer and she didn’t say anything until it got very
bad. She developed gangrene. The very first visit they
recommended amputation, but I wouldn’t give permission
because that is such a traumatic procedure. It took a year and
multiple hospitalizations for the infection to finally clear
up. But it only happened because she had a watchdog of a
daughter. In the retirement home where my mom lives, I’ve
seen several people who didn’t have watchdog daughters who
had amputations and who died after weeks of
"recovery."
One reason my mom has been in the hospital so
many times is that they keep sending her away too soon and
then she just has to come back. Every time they have tried to
make her leave, I’ve been able to force them to allow her to
stay longer. But it’s usually not quite long enough. They
have increasingly rigid guidelines for just how many days you
can stay for each condition.
My mom’s last crisis was that her heartbeat
slowed tremendously — down to 14 beats per minute. An
ambulance took her to the emergency room. And whenever she
goes to the emergency room, the minimum time before she is
transferred and admitted to her own hospital is 14 to 18
hours. All that time, she’s lying on a gurney. At least
twice she’s gotten bedsores while waiting to be admitted.
After her heart surgery, I had to try to find
my mom a nursing home with rehabilitative facilities that did
in-house dialysis. There are only six such places left in Los
Angeles. That’s because corporations have privatized
dialysis and contracted it out. A lot of places stopped doing
dialysis because it’s no longer cost efficient.
RED EARS
So I called these six places, and three of
them never returned my call. Still, I was on the phone for 14
hours one day and the next day for nine hours, trying to
arrange this care for my mom. My ears were bright red for two
days after that. Of the three places that did return my calls,
I talked to administrator after administrator. And they told
me, "Well, her HMO doesn’t pay enough, and we can’t
make a profit. So no, we will not accept her."
There was a rehab center my mom had gone to
many times before, but they didn’t offer dialysis. The staff
there worked with me to find the cheapest possible medical
transportation to take her from there to a dialysis center
three times a week. It would have cost $180 a week for three
5-mile round-trips. That’s $720 a month. And it wasn’t
covered by insurance! She finally wound up at a place that’s
about a mile away from the dialysis center. It’s run by a
caring young gerontologist who committed to pay for the
transportation if we couldn’t get Medicare to cover it.
All of this has been more than a full-time job
for me. But the fact is that a person in my mom’s condition
— and it’s not an uncommon condition — cannot live long,
nor can they have a good quality of life, without major
assistance. And in our culture today, that means help from a
relative or a dear friend who is not working a regular
full-time job.
I see people in the hospitals, in the rehab
centers, people who do not have relatives who can care for
them this way. And there’s an enormous difference in the
care they get. It’s everything from bringing them a piece of
fresh fruit to doing battle with their doctors and demanding
that they get proper medical attention.
I don’t mind helping my mom. What I mind is
that the burden is almost entirely on my shoulders, and that
the system is making it infinitely harder than it has to be.
In addition to caring for
her mother, Kathleen O’Nan chairs the Los Angeles Chapter of
the Labor Party. A major focus of the chapter’s work is
building the Labor Party’s campaign for Just Health Care, a
movement for guaranteed universal access to quality health
care, including "single-payer health insurance, publicly
administered and funded, delivered by a non-profit
system." Kathleen’s mother, Rosemary O’Nan, is also a
member of the Labor Party. |
