HMO ACCOUNTABILITY: A Mother’s Fight
All Dorothy Cancilla has to do is look at a photograph of her daughter, who passed away more than 13 years ago, to be reminded of the need for HMO reform. Cancilla says her daughter, Jenny Gugliello, died at the hands of the nation's oldest and largest not-for-profit HMO, Kaiser Permanente. And while the right to sue HMOs for damages resulting from delayed or denied treatment would not have affected Jenny (her family filed a medical malpractice suit directly against her doctors, a right that already exists in California), Cancilla believes the measure would help ensure patients get treated with the respect they deserve. "Right now [HMOs] can refuse you treatment," said Cancilla in a recent interview, "They can say it's not on their list or they just don't want to treat you for that particular ailment. And if they refuse, you cannot sue."
Cancilla also believes the $250,000 cap on liability needs to be expanded because it doesn't sufficiently motivate HMOs to provide quality care. In her soon-to-be-released book, "Death By HMO," she argues that the cap "is far less than the cost of caring for high-risk patients; this can lead only to the frightening conclusion that it is more cost effective to let some patients die than to treat them." The book is a highly emotional chronology of her daughter's progressively deteriorating medical condition, which a slew of doctors, including Kaiser's, were unable to treat.
Death by HMO
Cancilla readily admits that by the time her daughter Jenny went to Kaiser's San Rafael facility, she was gravely ill, having suffered severe intestinal pain for years. She had already undergone a series of operations (by non-Kaiser doctors) to remove her appendix, as well as portions of her stomach, small intestine and pancreas. A "badly botched" procedure had left Jenny a diabetic. Yet Cancilla believes that Kaiser doctors hastened her daughter's death through an array of negligent procedures, including requiring Jenny to administer her own intravenous therapy at home and prescribing antibiotics that only exacerbated her condition. Below is an excerpt from Cancilla's book: "Every time she had to inject medicine, she'd have to clamp the Hickman line, stop the pump, inject the medicine, flush the line, unclamp it, and restart the machine. She had to do this at least every three hours during the day. ... 'That was way over my head,' [Jenny's husband] Paul [later] stated, 'It was way over Jenny's head, too. ... [W]hen I was visiting Jenny in the hospital, she complained that the feeding tube site was raw and sore. ... When I pulled down the covers and lifted the edge of the bandage I saw yellow-green pus oozing from the site. ... They were supposed to change the sterile dressing every day and be alert for infections, but they weren't.' ... Jenny had to instruct the Kaiser staff on how to calibrate and use the pump that regulated the dosage of drugs and nutritional supplements into [her] catheter. When she was hospitalized at Kaiser, the nurses would often reach to start the pump before Jenny was ready or before the pump had been properly calibrated. Jenny would have to stop them and tell them what was wrong. They didn't know what to look for by themselves. ... This kind of negligence and ignorance was a real menace to her health. "Jenny's condition progressively deteriorated, complicated by Kaiser's decision "not to admit her when [her] catheter was broken ... and prescribing antibiotics that ... had already been found to be ineffective on her. ... With all Jenny's medical records available and her long history of catheter problems, the Kaiser staff should have been able to diagnose and treat her infection. As we now know, they didn't have a clue." When Jenny died in 1986, her husband and son filed a wrongful death suit against Kaiser; after nine years of arbitration, they received $175,000.
Kaiser Speaks Up
Kaiser spokesperson Tom Delby points out that Jenny Gugliello's case is not directly related to current health care legislation, since her family's case was a straight medical claim filed against her doctors, a case that drew in the HMO only because it employs its physicians directly rather than contracting with independent physician groups. Delby believes many of the complaints about HMOs "do not apply to Kaiser" since its physicians do not have to consult the corporation before recommending certain tests or referring patients to specialists. Nevertheless, many Californians lump Kaiser in with other HMOs. So much so, in fact, that the California Nurses Association has posted on its Web site a page called "Kaiser Casualty of the Day," with more than 20 entries detailing a Kaiser delay or care denial that has allegedly resulted in serious illness or death. The site also keeps close tabs on the hospital world, with "Tenet Watch," "Sutter Watch," "Columbia/HCA Watch" and "Catholic Healthcare West Watch" pages. The choice facing Gov. Gray Davis, should state Sen. Liz Figueroa's (D-Fremont) bill ever reach his desk, is a tough one. Giving patients the right to sue HMOs could drive up health care costs, as critics warn. It could also mandate greater accountability, as advocates hope. Even if health care reform is defeated this year, Cancilla hopes her book will teach others what she herself did not know. She warns, "When you are there, stop, yell, scream until you get the medical care you need. Make sure you know everything you can about the doctor and the hospital or talk to someone who can explain it to you" (Caroline Noel, California Healthline).