Limping to a Halt : Problems Engulf Staff and Patients as Anaheim Health-Care Clinic Closes for Good
Last week, workers at the General Med clinic in Anaheim had to call six ambulances before they could get one that would agree to pick up 66-year-old William Shelly of Fullerton.
Shelly, a retired Hughes Aircraft Co. employee, was experiencing problems related to a chronic heart condition. But word had spread within health-care circles that General Med was being shut down, and five ambulance operators in a row refused to take him to a hospital, according to Dr. Stanley Ermshar, Gen Med’s chief of medicine.
“Good care is critical for him,” Ermshar said. And with future health coverage uncertain, “he’s one classic example that could fall through the cracks and become a medical disaster.”
Shelly’s experience was one of many cited Friday as the financially troubled health maintenance organization closed for good.
Tell of Difficulties
Several Gen Med employees at the Anaheim clinic related tales of difficulties they had encountered in providing care during the 3 weeks since the closing was announced. And a number of doctors, nurses and Gen Med members who gathered at the facility to draw attention to their concerns raised questions about the future of members’ health care.
On March 7, Maxicare Health Plans Inc. announced the closing of its Orange-based Family Health Services Inc. subsidiary, known in Orange County as Gen Med. Although it was owned by Maxicare, Gen Med was a separate health maintenance organization that operated independently of the HMO clinics affiliated with Maxicare.
Maxicare, which is experiencing severe financial problems of its own, said that Gen Med members will be able to receive care until May 1 at clinics that are part of Maxicare’s existing network.
The closing left 55,000 Gen Med members looking elsewhere for medical coverage. For most, it has meant the inconvenience of signing up for a new health plan offered by their employers. For a few who weren’t covered under employer plans and had pre-existing medical conditions that other insurance companies wouldn’t cover, it has meant either joining the troubled Maxicare network or going without medical coverage altogether.
In a March 7 letter, Los Angeles-based Maxicare said that Gen Med members not covered by a group plan had until March 25 to convert to Maxicare coverage.
Worries About Treatment
Blayne Perenteau, a Gen Med member who last week suffered a ruptured appendix, said he isn’t sure where he’ll go for post-operative care. He said he worries about the treatment he will receive at Maxicare clinics from doctors he has never met. And he said he is concerned that Maxicare will not honor his request for coverage.
“They said March 7 they’d insure me,” Perenteau said. “Now they filed bankruptcy. Based on what I’ve seen, I’m not too confident of what’s to come.”
On March 16, Maxicare sought protection from its creditors in a Chapter 11 bankruptcy filing that allows the company to continue operating under court supervision while seeking to reorganize. But analysts have raised serious questions about the company’s ability to stay in business.
Anaheim resident Leon Randalls, a Gen Med member who has lung cancer, said he has called Maxicare’s offices to see if he will be covered by Maxicare, but “they say they can’t tell us for sure.”
Maxicare spokeswoman Tobi Nyberg said Friday that individual plan members who met the March 25 deadline will be covered under Maxicare plans. She added that coverage will be provided, even though “we had no legal obligation to take those people.” Nyberg said that about 300 members were covered under individual, or non-group, policies instead of group plans offered by employers.
Insurance industry analysts said that people who suffer from a chronic illness, such as Perenteau and Randalls, are not going to be accepted by other insurance companies, which carefully screen applicants.
Some members said that even if Maxicare accepts them, they are concerned that the company’s troubles might affect the care they receive. And they said they are concerned that their medical records might never reach their new doctors.
Doctors, nurses and staff members said problems with outside suppliers have increased in the days since Maxicare announced its intention to close Gen Med. They said the problem has become even more severe since the bankruptcy petition was filed.
Doctors said that some ambulance services, oxygen companies and other medical suppliers have refused to provide requested goods and services.
Dr. David Garcia, an internist at the Anaheim center, said that some health-care suppliers, including an Anaheim radiologist, have become “Good Samaritans” by taking Gen Med members without assurances that they’ll be paid.
Nyberg said that cases of supplier service refusal have been scattered and have been dealt with by the company. She also said that Maxicare will continue to meet its obligations to pay health-care providers.
Although several dozen employees will stay with the company for the next couple of months for administrative duties, most of Gen Med’s 500 employees, including about 300 in Orange County, received their final paycheck Friday. And many got much less than they expected.
Doctors and nurses were told March 7 that they would receive severance pay as outlined in their contracts. But Maxicare said the bankruptcy filing prohibited it from honoring that commitment.
Maxicare said it received approval from the bankruptcy court to pay $2,000 to each employee for all wages, benefits and business expenses owed at the time of the bankruptcy filing. Nyberg said the $2,000 would not cover the claims of many employees. In addition, she said, vacation time accrued before Dec. 16 will not be paid.
Employees said they expect to stand in line with other creditors if they want payment.
Gen Med workers, many of whom have taken other jobs, also have had to find new insurance coverage for themselves. For Dr. Anne Mazer, a Gen Med employee who is six-months pregnant, the insurance plan at her new company won’t cover the medical expenses of her childbirth because it is a pre-existing condition. She said she will be able to pay about $750 in premiums to Maxicare to continue coverage with the company.
“When you plan a baby, you don’t plan on switching jobs and insurance companies after 6 months. I have no choice.”
Gen Med’s last day was more confusing than anticipated because the company’s phone system was prematurely shut down. Nyberg said Pacific Bell had been instructed to cut phone service at 5 p.m. Instead phone service had already been disconnected Friday morning. She said the phone company was working to restore the lines.
“We were running out and calling patients on the pay phone,” Garcia said. “It was very bad. . . . But it was appropriate.”
