To alleviate any concerns, I’ll start with the happy ending of this tragic story. My 12-year-old son Dylan is just fine. His toe will heal, the staph infection will become a memory of the past, and if all goes well he will even play soccer again in the fall. That’s the good news! The bad news is the horrendous state of healthcare in America that has taken its toll on Dylan, his parents, and likely millions and millions more throughout our country over the years.
Four weeks ago, Dylan kicked the bath tub getting out of the shower. He got a deep laceration right below the nail on his big left toe. Not such a big deal at the time. Definitely not something that a band aid and some ibuprofen along with dad’s famous TLC didn’t take care of. Fast forward 2 weeks though, and he re-opened the wound twice jumping on trampolines and such at two different birthday parties. The second time was the clincher for this tale as one of his friends stepped on his toe – and the open wound – giving him not just a bad break to the bone but also creating the perfect storm of freak circumstances for a staph infection. By now, you are probably wondering what moved me to share this with you all. Well read on to see how the saga of horrors in healthcare has at best contributed to an unpleasant and effortful experience.
- Sat night, June 18th (the day after someone stepped on Dylan’s toe): For the first time in 2+ weeks, Dylan is noticeably limping on this foot. I look at his toe when we get home, ice it, and put him to bed with some ibuprofen hoping the swelling will go down overnight.
- Sun morning, June 19th (yes, Father’s Day… Good times!): Dylan waddles into my room with a swollen red toe that is clearly broken saying he was up all night in pain, so we go to the local urgent care center. Since Dylan is covered by his mother’s HMO insurance, I pay more than $300 out of pocket for an x-ray that confirms the seemingly obvious break and a prescription for Augmentin to treat the probable infection.
- Mon, June 20th: The swelling continues to the point I have to get a prescription for Tylenol with Codeine to manage Dylan’s pain while his mom continues to fight the HMO powers-that-be for an appointment with an orthopedic specialist which apparently isn’t possible for several days.
- Tues, June 21st:
- Dylan’s swollen toe is now white with infection, and he can’t even stand on it. His mother calls 9-1-1 for an ambulance because the only way to get “fast” medical treatment at this point will be if he is rolled into an ER by paramedics.
- The ER staff treats Dylan’s infection, but unfortunately the hospital the ambulance company is contracted with doesn’t have a pediatric unit so he spends another 8 hours laying in an ER bed waiting for the insurance group to negotiate and authorize treatment at another hospital.
- The authorization is finally granted well after midnight, and Dylan is transported from one hospital to another with his second ambulance ride of the day
I truly wish I could tell you the saga ended once we arrived at the second hospital. Don’t get me wrong. The care was phenomenal, and I will forever be indebted to the staff at Providence Tarzana Hospital. Dylan’s bone was reset, and although it took 4 days from his 1:30am arrival that Wednesday morning Dylan safely returned home. As ludicrous as it may seem though, the challenges with HMO insurance have continued well beyond any procedures that were performed in at Providence Tarzana. See below.
- Mon afternoon, June 27th:
- Dylan was required to see his primary care physician the Monday after returning home so the doctor could basically look at his wrapped foot and PICC line (basically a more permanent IV for ongoing home healthcare) and confirm he still needed a referral to an orthopedist and infectious disease specialist.
- After about an hour and a half in the doctor’s office receiving no real medical treatment, we finally left, and the doctor submitted the referral requests for the 2 doctors we had seen at the hospital – neither of whom were members of the medical group or had been approved at that point.
- Tues and Wed and even Thur, June 28th–30th:
- Phone calls continued for days to get the authorizations processed in time for Dylan’s first follow-up visit with the actual orthopedist who previously provided care.
Maybe I’m crazy, but this sure doesn’t seem to be the way clinical care is meant to be offered in our well-developed Western society. I sure don’t have answers to the many questions we could ask about why it did happen this way, and I am sympathetic to the medical groups and insurance companies who need to put certain controls in place to manage their delivery costs. There has got to be a better way though!
If this seems crazy to you too, I invite you to share your comments below. Maybe I’m missing something… Maybe you know of a better way… Until then, to your health, and to the health of those you love!
