When Did They Take the ‘Care’ Out of ‘Health Care’?

A recent brush with the modern health care system taught me what a growing number of people already know: It can work fine until you really need help, and then you may get a shrug and a “sorry.” To get health professionals to help you, sometimes they must be forced by intermediaries using special code words. In some cases, they will help you--but only in secret.

My education began on a Saturday when my 84-year-old mother returned home from a cruise weak and hacking. On Sunday, a doctor at a urgent care facility listened to her lungs, said it was either bronchitis or pneumonia, and told her to take antibiotics and see her doctor in the morning.

Early Monday morning, with my mother in a profound sleep, I began calling the medical group’s office. After four calls in as many hours, I heard that the doctor didn’t want to see her. “Give the medication a chance to work,” the nurse said. That would be five days.

The next morning, she was again asleep, even more deeply. I continued calling her doctor to no avail. It was only after I reached an intermediary advocate, a feisty social worker hired by the residents of Leisure World in Laguna Hills, that the office called back. They would see her that afternoon.

The social worker said frail, elderly people are languishing alone at home because they don’t know what it takes to get through managed care--”pushing bells, being obnoxious.” My mother’s case could be multiplied 1,000 times a day, the social worker said.

Some of my mother’s friends know not to call for an appointment. They camp out at the office, demand to be seen and refuse to leave. Even then, they can encounter the attitude I found at the office where, after complaining about waiting more than an hour, a nurse told me, “Well, she’s not dying.”

The X-rays showed pneumonia. My mother was placed in a hospital where she was given oxygen therapy for three days. Afterward, several of the professionals I had consulted said they had believed all along that she should have been hospitalized, but they were prevented from saying anything because they weren’t the “primary care physician.”

Last year, there were an estimated 3,000 official complaints about health maintenance organizations to the state’s Department of Corporations, which regulates and monitors HMOs. In reality, there are many more incidents--particularly among the elderly who may be too frail to complain, said Susan Gosselin-Bowlds, associate director of Health Insurance, Counseling and Advocacy Program, which is funded by a grant through the state’s Department of Aging.

“The name of the game is delay,” she said. “Delay and you keep the money.”

Even the smallest complaint should be filed, she said. Organizations can be punished and fined if they fail to meet federal regulations.

The elderly are not alone in their problems with managed care. Early one recent morning, I forgot to move my hand when I slammed the car door.

“Sorry,” the nurse said when I arrived at my neighborhood urgent care. “We don’t take HMO patients until after 5.”

Glancing from my swelling bloody finger to my narrowing eyes, she said, “It’s heartless, I know, but that’s the way it is.”

Some front-line workers are pressured to ignore pain and suffering. Some harden their hearts. Some quit. Others are joining a kind of underground resistance.

Still untreated, I happened upon one of those rebels. Hearing that I hadn’t seen a doctor, she said, “That’s not right.”

She led me down an empty corridor and told me to sit on a bench. “Wait here,” she said.

In a few minutes, a radiologist came flapping toward me. He didn’t make eye contact and he never introduced himself. The advice he was about to give, he cautioned, was unofficial; say it didn’t even come from a doctor.

“I’m just a friend,” he said. “A friend you never met before.”

He told me how to treat my wound. And then he vanished.

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Where to Take Your Complaints

Susan Gosselin-Bowlds, associate director of the Health Insurance, Counseling and Advocacy Program, provides the following numbers to lodge complaints about health maintenance organizations. In addition to complaining to your HMO, you may call:

* HICAP at (800) 434-0222.

* The state Department of Corporations at (800) 400-0815.

* California Medical Review Inc. at (800) 841-1602.

*

Lynn Smith’s column appears on Sundays. Readers may write to her at the Los Angeles Times, Life & Style, Times Mirror Square, Los Angeles, CA 90053 or via e-mail at lynn.smith@latimes.com. Please include a telephone number.