Doors Slam on Medi-Cal Mother’s Search for Orthopedist

It has been nearly three weeks since Rebecca broke her arm, the left one, when she and her sister were playing with some friends. She fell on it wrong, and it hurt really bad. Rebecca says it still hurts a lot.

The arm is in a splint, wrapped in a cloth sling tethered around Rebecca’s neck, but it should be in a cast. Rebecca is only 5 years old, so she doesn’t really understand the intricacies of this paradox.

But her mother, Virginia Campoy, does. That’s why she is crying now, suddenly, surprising even herself; the dam usually holds.

Except that I’ve told Virginia that her phone conversation, the one I’ve just overheard, sounded a little hard to take. It came on the tail of many similar calls over the past weeks.

Children’s Hospital already told Virginia it couldn’t help Rebecca, seeing as how it was closing its orthopedics clinic on July 1. At UC Irvine Medical Center, they said the wait was nearly three weeks. Rebecca’s pediatrician tried making some calls herself, as a favor, but without any luck. Then Virginia took over herself.

The calls go something like this. In her best friendly, assertive-but-not-too-assertive tone, Virginia will explain to the medical receptionist that her daughter needs the services of an orthopedist to set a cast on her arm. She does this from her apartment in Laguna Beach.

Then Virginia will say that an X-ray was taken at the hospital emergency room and that the cast really needs to be taken care of, and when might she be able to bring her daughter in?

Before, Virginia used to wait until she was asked about insurance, but now she brings it up herself. She tells the voice on the other end that Medi-Cal will be paying the bill, and that’s where the conversation ends.

“No, the doctor doesn’t take Medi-Cal,” the voice says, starting to frost. It is suggested that Virginia take her daughter someplace else.

Virginia has tried to do this, again and again.

“At this point, if my children get cancer, if they get AIDS, if they have an ear infection, we don’t get care,” she says, sobbing now. “I am worried about my children. I am really, really afraid. I fear that their world will be even worse than my own.”

Perhaps Virginia is overreacting. I do not know. My own children are well cared for; they see private doctors all the time. My husband and I have the money for that; each of us has private medical insurance from our jobs.

But if I were Virginia Campoy, a single mother, former battered wife and full-time student on government aid, maybe her reactions would be my own. This is a test that I’d rather not take. Virginia, too, desperately wants out.

“I always felt that I was a privileged child,” she says. “Even though we were Mexicans, we lived in a white neighborhood. We had a Mercedes. I went to private school.

“My father worked for North American Rockwell, on the Apollo spacecraft. We loved John F. Kennedy, and there was always a lot of pride in my family about my father working on this project.”

All of this seems very important to Virginia as she recites it to me now. Dignity is a word that she mentions more than once. What she is saying is that she has known better, before the wrong choices and the bad luck. This makes the hurt worse.

I took Virginia and Rebecca back to the hospital emergency room the other day because a social acquaintance of Virginia’s, a doctor, told her the hospital that first treated Rebecca had the obligation to follow through.

Virginia didn’t know this on her first visit there, so she had left nicely, meekly, grateful that her daughter was no longer crying out in pain. The doctor who attended Rebecca that night told Virginia to take her daughter to her pediatrician for a cast in about five days--after the swelling had lessened--and assured her that Rebecca would be fine.

But Rebecca’s pediatrician--in Fountain Valley because Virginia can’t find a nearby doctor who will accept Medi-Cal--could not set the cast. The doctor told them to go to Children’s Hospital but not to tell the hospital who referred them there.

That’s because Medi-Cal referrals are regarded as a curse. Doctors and hospitals say Medi-Cal doesn’t pay enough and even when it does pay, it is late. Paperwork is a nightmare, and it seems the hassles don’t stop. Most physicians don’t accept Medi-Cal at all.

Yes, hospitals have limited legal obligations to treat a person in need. There are even signs in emergency rooms attesting to that fact. But there are ways around that.

A pretty good one is to try to make a patient somebody else’s problem and direct her someplace else.

I’m figuring that’s what happened with Virginia when we went back to the hospital emergency room the other day. First the receptionist told her they could do nothing for her child. Then Virginia, smiling, very nice, said that she knew her legal rights. Superiors were then consulted, looks and whispers exchanged.

Then we waited a while. Finally a courteous woman, a marketing executive, emerged with a paper on which was written a doctor’s name. She said the staff had called this doctor and he had agreed to set the cast. It would be no problem, she said. Just give him a call.

This is what Virginia did once she and Rebecca returned home. This is the conversation that, finally, brought Virginia to tears. “No, we don’t take Medi-Cal,” the voice on the other end said.

“But, at the hospital they said. . .” Virginia is saying now. “I just came from there. . . .”

Finally, this mother strikes a deal. She will pay $5 a month toward the bill. The initial cost will be $226.

“Yes, ma’am, I’ll come with $5,” Virginia says into the phone.

Rebecca and Virginia went to the doctor the following day, the cast was set and another X-ray taken, too. Rebecca was thrilled with the teddy bears on her cast. Virginia said that she didn’t have the $5 that day, but that she would pay when she returned in two weeks.

“I have to say they treated me with respect,” Virginia says. “They were very nice.”

This is the end of this little story, for now. The dilemma lives on.