Cancer Survivor Leads Battle for HMO Patients’ Rights

A local patient advocacy group founded by a disillusioned HMO patient has flourished to such a degree it is now backed by the Ventura County Medical Society and its actions are cited nationwide as a way to make managed care medicine work as advertised.

A year after starting Patient Advocacy Management Inc., cancer patient Pamela Hasner-Owens is in a surprising position: With no formal training in health care, her efforts on behalf of frustrated patients now serve as a model of how to get the most out of HMO plans that can prosper by denying or delaying care.

In August, the county’s oldest HMO-affiliated physicians group endorsed her efforts and began referring its own patients to her for assistance.

In September, a German television company featured Hasner-Owens in a documentary as that country prepared for its entry into government-sponsored managed care.

In November, the local medical society endorsed her efforts and gave her free office space in its downtown Ventura headquarters. The California Medical Assn. then offered her a spot on its World Wide Web page.

In December, CBS news magazine “60 Minutes” flew her to New York for interviews about her troubles with HMOs and how she now fights to gain better treatment for others.

“I think our organization came along at just the right time,” said Hasner-Owens, 44. “People are really starting to feel the impact of HMOs. And more consumers are becoming more conscientious about what’s going on behind the closed doors of managed care.”

Apart from the growing backlash against the restrictions of health maintenance organizations, Hasner-Owens has gained credibility because of her own story--and the fact that her group has survived for a year on patient and doctor donations and modest fees.

One patient, a retired Oxnard man, expressed his satisfaction by donating $25,000. A Bay Area doctor gave $10,000, she said.

“We were struggling, waiting for that one-year mark as a nonprofit so we could apply for grants,” Hasner-Owens said. That date arrived this week. “We did everything we could to raise money, including selling chicken at the Strawberry Festival. We started this organization with passion, not a plan. We’ve learned some hard lessons.”

Her reputation has grown to the point where some local doctors refer their patients to her for assistance in getting specialty care promptly from HMOs. In turn, those doctors have contributed small amounts and large--up to $1,000 in one case--to keep her office afloat, said Frederick J. Menninger III, 1998 president of the 450-member county medical society.

“When we endorsed that group, we were for the most part endorsing Pam Hasner,” said Menninger, an Ojai physician. “She is a survivor herself, and she remains an advocate despite her continuing battle with disease. She helps patients wade through the morass of red tape that confronts them in dealing with HMOs, which are trying, in part, to deny care.”

A native of Georgia, Hasner-Owens worked as a real estate agent and then a public relations spokeswoman for a chain of San Diego appliance stores, before she arrived in Ventura nine years ago. She has been seriously ill off and on since 1986.

Struggled to Get Proper Treatment

And now Hasner-Owens--a survivor of breast cancer, heart failure and ovarian cancer--considers her life an HMO trial by fire. For 13 years, she has struggled to receive treatment she felt her HMOs should have provided without a fight. Inevitably, the expensive care she insists she needed was originally deemed unnecessary or experimental.

She now operates what she says is the only nonprofit group in the nation that intervenes directly for patients to secure treatment denied by HMOs. She heads a staff of three that fields about 1,200 calls a month from frustrated patients nationwide.

Since her story was printed in The Times last summer, the number of calls has doubled, she said. And she expects a similar surge after the “60 Minutes” segment is broadcast.

She intervenes directly in dozens of cases a month, stepping in to negotiate a peace among agitated parties--patients, doctors and HMO representatives who must sign off on specialty care. Twelve to 20 such cases are active at all times.

“We make the system work by being nice,” she said. “We let everyone know we’re not here to cause a problem, we’re here to solve a problem.”

That has worked to such a degree that the 42-physician Buenaventura Medical Group, among the county’s largest HMO-contract associations, posts blue-and-brass plaques at its five west county offices announcing its support for Patient Advocacy Management.

That is quite a turnaround, because Hasner-Owens had consistently cited Buenaventura as a prime offender in denying needed care to patients. In fact, she said she started her own hotline because of problems she had in getting Buenaventura to respond to her life-threatening heart and cancer problems.

Now, Buenaventura’s medical director, John Keats, sits on her board of directors. And Hasner-Owens says the physicians’ group has cleaned up its act.

“I’m seeing a difference over there, honest,” she said. “When we first started, we’d get a couple of complaints a day about Buenaventura. Now it’s narrowed down to a couple a month.”

When Buenaventura patients are upset, her group steps in. Sometimes, at Buenaventura and elsewhere, she finds doctors who are insensitive or worse. But she also finds that some patients are making demands that are impossible to meet.

“We ask them, ‘Are you really angry at your doctor or at your prognosis?’ ” she said. “Sometimes people will tell us that doctors didn’t detect symptoms the patients forgot to tell them about. So we’ll say, ‘Doc, the patient is upset because you weren’t psychic today.’ ”

Grants Needed to Keep Going

Keats said he now works regularly with Hasner-Owens.

“Her organization has the potential to be a real force in our community for helping patients understand managed care and navigate their way through this new system,” he said.

Mark Hiepler, a nationally known HMO malpractice lawyer from Oxnard, admires Hasner-Owens’ work.

“Her patients are the beneficiary of the fact that she is doing something that no one else wants to get involved in,” Hiepler said. “That’s because it’s not lucrative, it’s very difficult and it takes persistence that is immeasurable. The squeaky wheel gets the grease, and she helps people squeak in an effective manner.

“But what’s unique about her,” he added, “is that she is battling her own disease, so people know she is about a cause and not just making money.”

Yet, as Hasner-Owens completes her first year, she knows she has to secure grants from medical and government groups if her group is to survive. She is filling out her first set of applications this week.

And even as she plans for the future, Hasner-Owens is wrestling again with what her doctors believe is a recurrence of ovarian cancer. Exploratory surgery is set for this month.

“We’re going to survive, and I’m going to survive,” she said, “because I’m a survivor.”