HMO Reform Backers Cite Teacher’s Death

The focus of a statewide campaign to reform managed health care turned to Ventura County on Friday when supporters of Proposition 216 used the death of a 54-year-old Ojai schoolteacher to illustrate perceived ills with the HMO system.

C’Ann Scott, who taught in the Ventura Unified School District for 19 years before her death in February, was featured by the group as the “HMO Casualty of the Day” in faxes sent to hundreds of media and government organizations nationwide.

A nagging cough over Christmas flamed into bronchitis before Scott saw her primary care physician. As her condition deteriorated, she kept pleading to be admitted to the hospital for a mysterious swelling in her leg. A few days after her doctor approved admittance in February, she was dead from a massive blood clot. Her family believes her HMO’s reluctance to treat her cost her life.

Supporters of Proposition 216 say cases like Scott’s give credence to their ballot measure. One of two competing measures on November’s ballot, it aims at tightening government regulation of HMOs. Both would outlaw rules in some HMO contracts that stop physicians from telling patients about treatments not covered by their health plans. Proposition 216 would also establish a nonprofit corporation to be an advocate for consumers.

The California Nurses Assn., Ralph Nader’s consumer group and many labor unions support Proposition 216, while the state’s largest health maintenance organizations oppose both it and its rival measure, Proposition 214.

The series of heart-wrenching testimonials began Sept. 17. Every day until election day supporters of Proposition 216 plan to dole out a different poignant story to the media, aimed at chastising managed-care providers for what advocates consider patient neglect and case mismanagement.

Janet Maira, spokeswoman for the business coalition opposing Proposition 216, said the Casualty of the Day campaign is misguided. She declined to comment on the particulars of the Scott case, saying she prefers to focus on the problems with the proposition as a whole.

“I have to look at the entire picture,” she said. “I can’t be victim to the manipulation of their campaign tactics. They are taking advantage of people’s tragedies and using them for their own selfish purposes.”

But advocates for the ballot measures say the individual stories are the best way to make their case.

“We’re trying to put a human face on the human wreckage that is out there that nobody hears about,” organizer Elaine Burn said.

On Friday, that human face was C’Ann Scott.

In the one-page fax, her husband, Mark Scott, a part-time history instructor at Oxnard College, gives his version of what happened in the month before her death. The names of C’Ann’s physician and her HMO are left out, though it is titled, “How My Wife Died at the Hands of Her HMO.”

Scott declined to show his wife’s medical records to a reporter, citing legal issues. He has hired an attorney, Los Angeles-based Dr. Bruce Fagel, who said he expects to file a lawsuit against the HMO and the physician later this year.

Scott did not provide Proposition 216 supporters with medical documentation of his wife’s case either. But even without proof, Burn said she felt comfortable using Mark Scott’s version because it was so compelling and it told a story she said she is very familiar with.

“It is so common,” Burn said. “We have hundreds of stories like this.”

As Mark Scott tells it, C’Ann’s troubles all began with a cough a few days after Christmas. The couple repeatedly asked to see C’Ann’s primary-care physician, but were turned away by the physician’s nurse, Mark Scott said.

They settled for an emergency clinic affiliated with her HMO, where they received medication for bronchitis. C’Ann started to ask whether she should be hospitalized.

Scott said when his wife finally got to see her own physician at the end of January, she asked the same question. He said the doctor gave her an inhaler to use at home to clear her breathing passages. At night, her wheezing woke her husband.

On Jan. 25, she received written permission to go back to teaching her second-grade class at Elmhurst Elementary School in Ventura, a job teachers and her husband said she loved. Teachers at the school said they were happy to have her back, but were concerned about her health.

“Everyone was questioning her, saying, ‘Are you sure you should be here?’ ” third-grade teacher Ursula Rowe said.

C’Ann began limping. Her left knee was swollen.

Mark Scott said the doctor had determined it was probably an allergic reaction to the steroids she had been given earlier.

Soon her leg puffed up to twice its normal size. A few days later, it turned red and purple. On Feb. 8, she woke her husband and told him to drive her to the hospital, Mark Scott said, adding that she was admitted and diagnosed with phlebitis--inflammation of a vein. On Feb. 11, she was moved to the intensive-care unit. That evening, he said, they were told she needed medication to break up a blood clot in her leg. There was a small risk--5%--that she could die from the medication. The couple decided to take that risk.

Mark Scott said when he left the hospital that night his wife seemed fine. But when he came by to see her in the morning, he was told she had died early that morning.

On her death certificate, the immediate cause of death is listed as a reaction to the drug she had been given for a blood clot, a condition coroners indicated she had for four days. In addition to the phlebitis Mark Scott already knew about, coroners listed cellulitis--inflammation of connective tissue--as a cause of death. Other contributing factors included bronchitis, aspiration and asthma.

Her family is convinced she would not have died if she had been admitted to the hospital earlier.

“They didn’t put her in the hospital until her leg was twice the size it should have been,” Lisa Cox, C’Ann Scott’s 30-year-old daughter, said. “She should have been hospitalized weeks before that.”

Mark Scott and Cox both said they don’t believe C’Ann’s case is an isolated one. They hope that by having her case highlighted as a Casualty of the Day, they can help change a system they believe is flawed.

“I never really thought much about HMOs or doctors,” Cox said. “But now I am starting to read up on it. Something needs to be done, that is for sure. I don’t want this to happen to someone else’s family.”