Put Children’s Health Care First

It has been an eventful year in our family. Our son completed his first year of kindergarten. He showed signs of artistic talent, began to read, was accepted into a high-ability magnet school, began seeing a psychologist and began taking medication for attention deficit hyperactivity disorder.

Likewise, I have spent the year wrangling with people on the telephone, becoming a near expert in HMO-speak and worrying about authorizations for treatment. I recently footed the bill for a doctor who looked my wife in the eye and refused to see my son unless she wrote him a check. The good doctor said the health maintenance organization wasn’t paying him and urged me to pester them about getting him his money.

Profits, not people, are the bottom line.

More than a year ago, our son’s preschool teacher told us that she was concerned about his inability to follow directions and keep his hands to himself. He had no friends. When our son began kindergarten, his teachers made note of “troublesome behaviors,” which included “rocking, crawling, spinning, chewing on his clothing or pulling on his cheeks.” They also mentioned an acute sensitivity to “typical classroom noise.”

While not wanting to overreact to my son’s “unorthodox behavior” at school, I also was determined to intervene as early as possible. Following my HMO’s procedures, I obtained a referral to a specialist, a pediatric neurologist.

The procedure went as follows: Visit the neurologist for about five minutes, have him prescribe a sedative used for children with ADHD and then tell us he wanted to see our child for a follow-up in about eight weeks to check the effect of the medication. Simple enough, but the doctor’s secretary said she couldn’t make an appointment for us until we received authorization for another visit.

And when would this authorization come? This was out of our control. In fact, seeing a specialist often demands a relentlessness in the face of unreturned phone calls, long waits on the telephone and customer service employees who spout policy and little else. Would that President Bush had to gain authorization before having his colon checked.

And what is this magical word, “authorization”? In our case, it meant that another doctor, who had never met our child, who was not experienced with treating ADHD, who did not even work with children, decreed that our son’s problem was behavioral and not neurological. (Even a cursory reading of the serious literature on ADHD will refer to a neurological basis for the condition.)

Meanwhile, our doctor, unbeknownst to us, threatened to terminate his contract with our provider, leaving our son to go elsewhere. Where? That wasn’t his problem.

So whose problem is it when the system fails a child? Is “fails” too strong a word? After all, ours is not a life-or-death situation. Tens of millions of Americans remain uninsured, whereas, for basic health care, the HMO system generally is working for our family.

After numerous discussions with our health group, a psychiatrist, instead of a neurologist, will prescribe medication for our son. Still, many parents have neither the time nor the money nor the education to seek specialized help for their children. As a result of this, many children reach high school with undiagnosed learning disabilities, nearly illiterate and unable to control their speech or behavior. Against a backdrop of corporate scandal, we, as a society, will ultimately pay the price for putting health-care profits ahead of our children’s well-being.