Woman ‘Dies’ Twice in Snarl of Red Tape

Martha Lawler died in February, on a Friday afternoon, her body racked by emphysema. It was the second time in 10 months.

The first time, in April 1998, neither she nor anyone who knew her was aware of her death. She went along with her daily life in Indianapolis, breathing oxygen from tanks, making an occasional foray to a restaurant.

Then, in June, she heard the news: She was dead.

Somehow Medicare had gotten word of her passing and had cut off reimbursements for the oxygen that kept this 83-year-old woman alive. When Social Security was informed, it stopped her monthly payments of $994.

Over the last months of her life, Lawler tried again and again to tell the government she was very much alive; at the same time, she tried to find out why anybody thought she was dead in the first place.

She had her suspicions, but it wasn’t until a month after she died that those suspicions were confirmed: After she fired a hospice company, Odyssey HealthCare, it reported her dead.

The company blames a keypunch error; an investigation is underway. But no probe is necessary to prove that a dying woman was forced to endure needless misery because of the actions of Odyssey and the government.

“No one would help us,” says Lawler’s daughter, Jane Joyal. “Everyone would say, ‘Oh yes, it’s fine.’

“But it wasn’t. It just got worse.”

Her mother had been healthy most of her life. A widow since 1968, she had worked for Indiana Bell Telephone in the repair department; she reared four children, lived to see 13 grandchildren and enjoyed the quiet pleasures of collecting thimbles and paperweights.

In 1992, she was diagnosed with chronic obstructive pulmonary disease. The downward spiral began--bouts of pneumonia and then an ever-increasing need for oxygen. Insurance and Medicare paid the bills.

Two years ago, her health worsened. “In order to go out, I would have to take her in a wheelchair to my car,” her daughter says. Still, she would go out to eat on occasion, a small oxygen tank in tow.

All the while, she was in and out of the hospital. But last year, Dr. Linda Huck told the family she should be kept at home and made comfortable. She recommended that Odyssey be engaged to manage her care.

Odyssey has 21 offices, with headquarters in Dallas. Its aim, according to the company Web site, is to “serve all people during the end of life’s journey.”

The site poses a frequently asked question: “Is there any special equipment or changes I have to make in my home before hospice care begins?” Answer: “Your hospice provider will assess your needs, recommend any necessary equipment, and help make arrangements to obtain it.”

And, indeed, when Odyssey case manager Debi Vaughn came to Lawler’s apartment April 7, 1998, she had a lot to say. “You do need our services, and this is what we’re going to do,” she said.

You need a new hospital bed, Vaughn said. And a new oxygen provider. And we’re going to put you on new medications. The government will pay for it all.

Lawler said she wanted to talk to her daughter.

“You need this,” Vaughn replied.

(This is how Lawler described the meeting to her daughter. Vaughn no longer works for Odyssey and could not be reached for comment.)

The next day, Vaughn called Lawler several times.

Finally, Joyal talked to the case manager. Her mother was happy with her old bed, Joyal said, and she wanted the oxygen tanks, not a machine that produced oxygen, as Vaughn had insisted. It was too noisy, and what if the power went off?

“Every hospice group has providers they use,” Joyal recalls being told. “This is our provider, and this is who we will be using.”

Vaughn met the next Monday, April 13, with Joyal, her brother and her mother. According to Joyal’s account, she finally told Vaughn: “Mother doesn’t want your services.”

Vaughn begged the family to reconsider.

“Your mother is in our computer,” Vaughn said.

“Then take her out,” Joyal replied.

“No, you don’t understand. She’s in our computer.”

Vaughn was asked to leave, and she did, but with some parting words: “You know, Mrs. Lawler, you will be sorry. . . . You do need our services.”

Two months later, June 12, Joyal heard from her mother’s oxygen provider, Apria: “You know, Mrs. Joyal, we have a problem. Medicare has refused to pay their portion because your mother is dead.”

Her mother cried. She feared that her lifeline, her oxygen, would be cut off. (It never happened; Apria continued to make deliveries, believing it eventually would be paid.)

When Joyal called Medicare, she was told her mother had been reported dead April 13--the day of the last meeting with Vaughn.

Social Security officials said Lawler would have to come into the office, with identification, to prove she was alive.

“It really was an effort,” Joyal says. She had to pack up her mother, her wheelchair and her oxygen and drive her to the office. But at least Lawler was assured that the problem had been solved.

Then, on July 3, her Social Security money did not arrive.

Joyal called Social Security. Sorry, she was told; Lawler’s death was still in the computer, but now it was fixed. A week later, an emergency check arrived.

Lawler was trapped in an endless loop. Each month, her payment did not arrive; each month, she was told that the error had finally been fixed. And the next month, it would happen again.

In September, Social Security deducted $1,988 from Lawler’s bank account--the May and June payments she received after her reported death.

“It was a matter of not fixing everything that needed to be fixed,” explains Mary Mahler, a spokeswoman for Social Security.

Social Security workers deleted all references to Lawler’s death from their computer system, she says, but because Medicare still listed her as dead, the computer refused to issue her checks.

Lawler wrote to Sen. Richard Lugar (R-Ind.) requesting his help. Lugar put his deputy state director, Lane Ralph, on the case.

Ralph went to the Health Care Financing Administration, which administers Medicare, and asked: Who reported Martha Lawler dead?

The answer, as Lawler suspected, was Odyssey HealthCare.

Authorities traced the report to a billing form filed electronically by Odyssey on April 13. In one field, an Odyssey worker should have typed 30--code for “patient ended services”--but instead typed 40.

In other words, “expired at home.”

According to Pat Skogan, Odyssey’s vice president of clinical and regulatory affairs, this was a mistake, pure and simple. All other records, she says, accurately explained that Lawler was alive and had chosen to drop Odyssey’s service.

She said the company now double-checks its discharge lists each month.

“We’re a big company,” Skogan says. “Human error does exist. We’re very sorry that this happened.”

Was Vaughn overly zealous in her dealings with Lawler? Skogan says the case manager was merely giving Lawler enough information to make an informed consent, under the law.

Yes, she would have had to change beds. Lawler was renting from one equipment supplier, and Odyssey rented from another, Skogan says. As for the oxygen, she says the company would have arranged to deliver it in tanks.

Skogan says the Indiana Department of Health and the Health Care Financing Administration have informally cleared Odyssey of any wrongdoing. But an HCFA spokesman in Washington, speaking on condition of anonymity, says the investigation is not finished.

As for Social Security’s role in all of this, its spokeswoman, Mahler, says the agency is “very sorry this happened.”

Mahler says upon receiving reports of deaths, Social Security does not wait for death certificates. Instead, it cuts off benefits and relies on the undead to come forward to set the record straight.

Martha Lawler spent her last months “worried, worried, worried” about her Social Security and Medicare benefits, says her daughter. In her last days, she did receive hospice care, from St. Vincent’s Hospital. She died at home Feb. 19 and was buried at Washington Park East Cemetery.

It was April 12--365 days after Lawler was falsely reported dead, and nearly two months after she actually died--before Social Security repaid the last dollars she was owed.