Ex-Patient Uses Her Travails to Help Others Through System

Pamela Hasner considers her life an HMO trial by fire. For the last 12 years, she’s tested the new world of managed-care medicine and found it wanting.

But the 44-year-old Ventura woman--a survivor of breast cancer, heart failure and ovarian cancer--has mounted an offensive on behalf of patients baffled by a medical bureaucracy that can prosper by denying care, or delaying it.

“I considered hiring a lawyer after my ovarian cancer,” said Hasner recently. “But instead I decided to start an organization and direct everything I’d learned into something positive.”

Now, 10 months after founding Patient Advocacy Management Inc., Hasner operates one of the few nonprofit groups in the nation that intervenes directly for patients to make HMOs work as advertised.

Tanned and fit, with her cancer in remission and her heart problems under control, Hasner directs a bustling Ventura Harbor office staffed with one paid assistant and several volunteers.

They field 500 to 600 calls a month, she said. Many callers are helped with simple step-by-step advice on how to get the treatment they think they need.

“If you have cancer, there’s a place for you to go. If you have heart disease, there’s a place for you to go. But if you feel lost and helpless with managed care, you have nowhere to go,” Hasner said. “So we’re the place.”

Hasner said she intervenes directly in dozens of cases each month--stepping in to negotiate a peace among agitated parties--patients, doctors and HMO representatives who must sign off on specialty care.

“We make the system work by being nice,” she said. “We identify their case manager [at the doctor’s office] and their insurance company, and we give them a call. We start off by explaining what the problem is, and we do it gently. We let them know we’re not here to cause a problem, we’re here to solve a problem.”

By word of mouth and aggressive promotion, Hasner has pieced together a board of directors that includes a doctor, a psychologist, a chiropractor, a pharmacist, a lawyer, several nurses, an architect, a social worker, a private investigator and a mother whose daughter died while under treatment by an HMO.

“Pam’s an extraordinary person,” said director Ann Kelley, an Oxnard oncologist. “And her organization is very badly needed. Patients who belong to complicated health organizations do need advocates to get their needs addressed in a timely manner. And she has a non-litigious approach.”

Funded on a shoestring, Hasner’s group has raised $125,000 so far. That includes a $10,000 donation from one Bay Area doctor and a $25,000 gift from a satisfied local customer. Client fees are collected on a sliding scale based on income. And she is now soliciting support from companies in exchange for assisting their employees with HMOs.

Fred Martinez, 68, a retired phone company installer, said he made a large donation to Hasner’s group not only because she helped him, but also because her motives are pure.

“She’s a beautiful person,” said Martinez of Oxnard. “And this group is very important.”

Martinez personally discovered how well Hasner does her job a few months ago when his left leg, which was damaged by burns years ago, began to swell, and his doctor told him to go home and elevate it.

“I called Pam and told her I had an unusual swelling in my leg,” Martinez said. “She told me exactly what was wrong and to go immediately back to my doctor. He sent me to another doctor and they did an ultrasound of my leg. I had a restriction on the artery of my left leg, just like she said.”

“I have nothing against my doctors,” Martinez said. “It’s just that the HMO situation is something that holds you back if you want something extra.”

Hasner’s reputation has grown to the point where some local doctors’ offices have begun referring their patients to her for assistance in getting specialty care promptly from HMOs, she said.

Patients also hear about Hasner from the local cancer society, in which she is active, and because she hosts fund-raisers at such events as the Oxnard Strawberry Festival, where she sold fried chicken.

Ventura chiropractor Jeffrey Ando said Hasner recruited him to her board of directors after seeing his name on a volunteer list at a local homeless shelter. And recently he saw her work firsthand after referring an employee, Linda Peck, to Hasner.

Peck feared for her father, James Ware, a 78-year-old heart patient from Oxnard who had been sent home from the emergency room at St. John’s Regional Medical Center after many ounces of fluid were drained from his lungs. Two days later, his legs were swelling back up.

“I know what congestive heart failure is; I’ve had it,” Hasner said.

So she immediately called Ware’s new doctor, Ted Hostetler, who contracts with the Secure Horizons plan for senior citizens. The office staff had told Ware’s daughter that no appointment was available for four days. A receptionist initially told Hasner the same thing. In fact, Ware was changing primary care doctors and Hostetler was not officially his doctor yet.

“So I said, ‘What should I do? He needs help.’ ” Hasner said. “ ‘Will you please give the doctor a message for me?’ The doctor called back in 15 minutes. He saw Mr. Ware immediately, and put him back in the hospital.”

Peck was thankful: “Pam was very effective,” she said. “Without her I would have been at my wits’ end because I really didn’t know where else to turn.”

Ando was impressed.

“Pam overwhelmed them with kindness by treating the office manager really, really nicely,” he said. “And everybody in this business is used to so much negativity, everything’s so difficult, and there’s so much confrontation. So to be treated with respect gets you where you want to go.”

Hasner says she’s been a diplomat in training since 1986, when she was diagnosed with breast cancer.

Then 32, she was pregnant and her doctors told her she had only 90 days to live and recommended an abortion. Her HMO initially refused to pay for a second opinion, but she got it anyway. The prognosis was still bleak. But she delayed chemotherapy until after her son was born. And she survived after a barrage of cancer-killing treatment.

Nine years later, Hasner’s heart, damaged by the chemotherapy, began to fail. And she lobbied her Ventura HMO-contract provider for a referral to UCLA Medical Center to see if she was suitable for a heart transplant.

“They didn’t deny me,” she recalled. “They just didn’t acknowledge me. I waited for four months.” Then the Buenaventura Medical Group gave her a referral for one appointment only, she said.

She praises her primary care physician, Dr. Mark Smith, then at Buenaventura. But she says the institution gave her the runaround. Smith, now at a county clinic in Thousand Oaks, said he didn’t consider Hasner’s referral urgent.

“A cardiologist said maybe she needs to be on a heart transplant list, and I thought it was worth checking out,” he said. “But that was probably a debatable referral. And, in retrospect, she still has her same heart.”

Her heart did get better, but her health did not. Before long, her stomach ached and became swollen.

A series of doctors told her she was depressed or had a strained back or was entering menopause.

“I looked like a starving Ethiopian child with a distended belly,” she said. “My pharmacist asked me if I was pregnant. And I just broke down and cried.”

Finally, she went to the Ventura County Medical Center’s emergency room in June 1996, where a doctor-in-training suspected cancer and referred her to Dr. Kelley.

Kelley found ovarian cancer, which is now in remission.

And Hasner, despite her anger at HMO medicine, is determined to move ahead.

“We’re not fighting the system,” she said, “we’re trying to make it work better than it did for me.”

She finds support in unlikely places. Buenaventura’s medical director John Keats now works with her regularly.

“I think what she does is great,” Keats said. “I’m sympathetic to patients who don’t know what they’ve signed up for when they take on a managed-care plan.”