Woman Savors Victory in Long War With HMO

Terry Preston toiled in obscurity for four years, trying to persuade government authorities to hold the state’s biggest HMO responsible for her mother’s death.

But today Preston’s living room is an impromptu television studio--dark cellophane covers her windows, wires crisscross the wall-to-wall carpet and sequestered dogs nose at the bedroom door.

The phone rings: It’s Tom Brokaw’s producer checking on the taping. It rings again: Dan Rather’s crew needs directions. Once more: National Public Radio wants an interview.

The catalyst for this media blitz was a $1-million state fine--the second-largest ever and the largest involving a single patient--levied last week against Kaiser Permanente for allegedly ignoring Preston’s mother’s pleas to see her doctor two days before she died. The penalty includes 27 pages of changes the HMO must make.

Margaret Utterback, 74, essentially bled to death Jan. 28, 1996, from a ruptured abdominal blood vessel--a problem that state documents indicate progressed hour upon painful hour after she first called her health maintenance organization for an appointment.

What sets Preston apart from many grieving daughters is that she did not give up, although, until last week, the response to her every inquiry was “No.”

“You have to suddenly have all this energy to persevere in the face of tremendous odds and a tremendous emotional blow,” said Sara Nichols, California director of Neighbor to Neighbor, a consumer advocacy group. “Most people bow out at a certain point; she obviously didn’t, which is great.”

Preston’s quiet resolve emerges as a television cameraman paws her photo album for a picture of her with her mother.

“Oh no, I look awful there,” Preston says in her mellifluous voice, laughing as she gently reclaims the album. “You’re not getting that one!”

Preston is also unusual in today’s litigious world because, despite her determination to right a wrong, she never filed a lawsuit against Kaiser. She says she never will.

The decision was partly philosophical: “I just could not imagine accepting any amount of money for my mother’s life.”

But it also was strategic. Preston did not believe a legal settlement could effect change. “It would never hit the papers; nobody would ever know about it,” she said. “If the state slapped Kaiser with a fine, everybody would hear about it.”

Indeed they have. The headlines told it all: “Kaiser Fined $1 Million,” said the San Jose Mercury News. “State Seeks $1 Million From Kaiser for Death,” said the San Francisco Chronicle. The Times said, “Kaiser Fined $1 Million in Patient’s Death.”

The state accused Kaiser of “systemic health care delivery problems” that delayed Utterback’s treatment. Kaiser is entitled to a hearing on the findings and has vowed to fight the penalty, saying that the problems were not systemic and that some changes in patient protocol already have been made.

Looking back, Preston divides her crusade--for that is what it became--into three phases. The first was her naive period; then came bureaucratic and political phases. In a thick binder of correspondence on the subject, the first letter is to Kaiser, the last to Gov. Gray Davis.

The youngest of Utterback’s five children, she put her life and her master’s degree in animal behavior on hold, even as friends and family encouraged her to let go.

“What drives me is I really believe we need to respect life, and there was no respect for [my mother’s] life,” she said.

The crusade was born at Utterback’s deathbed. There, Preston’s sister, Barbara Winnie--who had spent most of the day with their mother--outlined Utterback’s futile attempts to get help. Those observations ultimately were confirmed by the state’s investigation.

Utterback woke up with a pain in her side and began calling her doctor, only to be told no appointments were available. After repeated calls, she finally got a 4:15 p.m. slot, but showed up two hours early in tears. She was not seen until 4:30.

Almost immediately her doctor diagnosed an aortic aneurysm and paramedics were called, but an hour passed before Utterback reached the hospital. Once there, her aneurysm burst within minutes. She was rushed to surgery, but the hospital staff was never able to stabilize her.

Within days of her mother’s funeral, Preston began writing letters. One of the first, to Kaiser, itemized reforms they should make, such as: People in pain should not have to wait to be “fitted into the doctor’s schedule,” and “erring should be on the side of the patient.”

“I truly thought” Kaiser would make those changes, Preston said last week. Instead, the physician-in-chief of Kaiser’s Hayward group wrote to express his “personal sympathies” and thanked her for her concerns.

That marked the end of her naivete.

She filed a complaint about her mother’s doctor with the state Medical Board. The claim was rejected. She got a second review and was rejected again.

But in that 1997 rejection, Preston found encouragement. Though the board determined that the physician could not be blamed, its rejection letter observed that the issue “could be considered to be a system problem.”

By then Preston was pursuing a state Department of Corporations investigation of Kaiser’s role in the death. The probe was closed in March 1997, then reopened the next year after a state attorney suggested privately that she get her assemblyman, Michael Sweeney, to intervene.

When the California Nurses Assn. advised her about the impact of HMO cost cutting on quality of care, she began including information about Kaiser’s profits in her correspondence. When an Assembly aide clued her in on the power of the HMO lobby, she did some lobbying of her own--sending packets of information about her case to all the state and federal legislators from her area, to the governor and to the president. She included an 8-by-10 color photograph of her smiling mother with every letter.

Yet just as things finally began to look promising in January, Preston said, she was told by Department of Corporations officials that the Davis administration had called for negotiations with Kaiser toward a possible settlement.

The governor’s office says the administration reviewed the case at the behest of the department, which department spokeswoman Julie Stewart confirmed. Regardless, delays piled atop delays, with final resolution promised--on Mother’s Day.

She fired off pleading letters to everyone involved, including the governor. The governor’s office now says the letter was forwarded to the Department of Corporations.

Less than two weeks later, as Preston waited for her son to run in the Northern California community college track finals, her pager beeped. She called after the race.

The result was double euphoria: Her son won his race and Preston won the first victory of her four-year fight.