:: to the teeth ::    thoughts on social justice, medicine, race, hope and beats

"Another world is not only possible, she is on her way.
On a quiet day, I can hear her breathing." :: Arundhati Roy ::

"The most common way people give up their power is by thinking they don't have any." :: Alice Walker ::
Friday, May 27, 2005  

Topahkal Patient Stories

This was an amazing week at the clinic and one more day to go. We saw about 35 patients so far, not to mention alot of phone calls. I had the wonderful help of a volunteer nurse practitioner, Lorraine, and a family practice doctor, Em. Thanks!!!

The week started off with a medical urgency. While I was sitting at UNMH financial aid office helping a lady sort out her $15,000.00 in bills from her pregnancy (see next paragraph) I was called by a family about a grandfather who could no longer pee. It had been about 16 hours and that starts getting quite uncomfortable and eventually downright dangerous. This grandfather was here on vacation from Mexico visiting his children and grandchildren. He had insurance in Mexico but was in a bind. Without insurance here, he was caught in the limits of the safety net. He needed a fairly simple procedure, the placement of a Foley catherter to allow him to pee. None of the clinics do this routinely so his only option would have been the ER or private urgent care at a cost of $200-500 or more. Fortunately, I had one foley catheter sitting around and was able to meet him in my clinic. I put in the foley, got about 1 liter of urine out and sent him on his way. The foley can stay in for 3-4 weeks safely so he had time to finish his visit with his family and then follow up in Mexico with his regular doctor for definitive treatment. cost was $55. and i'm ordering more Foleys.

So check out this story. The lady i mentioned is undocumented. During her pregnancy she developed a rare autoimmune condition and required hi risk prenatal services. she was told by her doctor that it would all be paid for by a special fund. after her pregnancy was over she received over $15,000 in bills from the hospital. Until the Coalition for Health Access got involved, she had been unable to make progress in sorting out even a payment plan. At her financial aid appointment this week, it became clear that she had been double billed by the hospital. They had already received payment from the special medicaid fund and were billing her anyways. The financial person apologized for the mistake and promised to rectify the situation...

If only I could make all the money I help people save... $15,000 wiped out in one short meeting. Granted, we had to wait about 3 hours to get to see the financial person but that is still a good hourly non-paid rate...

One more story from this week. All hands go to NUTRITION! Last week a grandma came in complaining of back pain. she looked miserable. She had a 2 1/2 yo boy with her who was freaking out wild, biting her, jumping on her, hyper as can be. After an exam it looked like she had a back strain but more importantly, a sugar addiction problem with her grandson which was exaccerbating her pain to the point of breaking. We spent a significant amount of time talking about nutrition and kids and growing bodies and hyper-ness and boundaries as a healthy thing. She left feeling a little better. I scheduled her for one of the volunteer massage spots (thanks JESSIE!) this week. I saw her today after the massage, she received craniosacral work, and didn't even recognize her. she looked like a vibrant young woman. Turns out it wasn't a back strain, it was a varicella zoster outbreak as evidenced by the new lesions on that part of her back. with the grandson, things had shifted alot. she had fought him with love and boundaries for a few days, withholding the sugar and keeping a firm hand on his behavior. after 4 days he was working with her and choosing not to eat the sugar. by the time i saw her, a week later, he was calmer, better behaved, playing nicely with other kids. Cure!

aziwa

posted by andru | 5/27/2005 06:03:00 PM | (1) comments |


Friday, May 20, 2005  

Last week I "voluntarily" resigned my position as adjunct faculty member and locum tenens provider at the University of New Mexico Hospital. I joined a long and growing list of people who have either been pushed out or have read the writing on the wall and chosen to leave.

For me, it was a solid push. The precipitating incident was a phone call i made to one of the family practice clinics. Our public hospital had just instituted a new draconian policy of up front payment prior to being seen. Sounds benign enough on the surface, it's how many businesses operate. yet this is a public hospital. Let me share a story that brings it all to light so that you can understand why i took the step that got me kicked out.

a 17yo woman, pregnant, is getting her prenatal care at an outlying clinic. Her doctor decides she might be dehydrated so she sends her to the hospital for evaluation. At the front desk this person is asked for $35. She doesn't have it. She is told to go home and come back when she has the money. fair play? after advocates (my friends) arrived, this young woman was admitted for two days for IV rehydration. this also happened to a 14yo pregnant girl two weeks ago. she was coming in for her first prenatal visit and was turned away at the front desk for lack of $35. Ask the CEO about this and he says it was an error on the part of the front desk folks. Well... yes. It was their mistake to believe that a policy put in place by him was ethical and worth following.

So the policy had just been put in place one month prior. Our CEO was saying in public that only 25 people had been affected and only 18 of them had been turned away. I didn't believe him. I didn't believe that there was even any data being collected. So here was my crime. I called a clinic and asked the front desk person if they were collecting data. This person stated that she was told not to speak to anyone about this new policy, she couldn't help me. she transferred me to her manager and that's where the sparks started flying. I identified myself as a UNM physician (that's what my badge says) and I stated that I was doing community based research. My research question was - "Are you collecting data on how many patients are turned away because they don't have their copay?" this really iritated the manager and she became defensive, I became frustrated, we went back and forth and finally hung up on each other. I never got my answer.

Turns out she reported me to her boss who reported me higher and higher and higher until it became this huge "thing." I got a call two days later from my boss who said that we had to talk. Bottom line, I was accused of misrepresenting myself as a UNM Physician and of doing research without IRB approval. I was told that my action (a phone call) was unacceptable and warranted immediate resignation or else I would have my privileges suspended and be reported to the state licensing board. Inflated charges, ruined credit. The same treatment many of my patients are reeciving financially by the same bullies. poetic justice? I chose to resign to avoid a large fight so that I could continue to pump my energy into creating positive solutions to this mess.

This is NOT going to stop me from speaking out. As a matter of fact, it has inspired me to organize the many people who have been kicked out or chose to walk away. We are going to start by creating a bumper sticker and tee shirt - "UNMH - Been There, Done That."

aziwa

posted by andru | 5/20/2005 01:17:00 PM | (4) comments |


Thursday, May 05, 2005  

The other day i was eating lunch at a restaurant near my clinic, talking to the owner about vegetarian mexican food. he's this great chef who can do wonders with eggplant. a friend of his came in who looked really familiar to me but i couldn't totally place him. i said hello and we tried for a few moments to connect. well, it turns out that he remembered who i was later and found me in my clinic for a medical problem. he had been a patient of mine when i was a resident at the Family Practice Center in Albuquerque.

I was shocked he was still alive. When I had met him then, he was barely recovering from congetive heart failure with cardiac function below 20%. he had been advised by cardiologists and others to basically not move, maintain a sedentary lifestyle and cross his fingers for a few months or a year to live. I felt a little nervous then about advising folks against the advice of specialists, being a resident and all, but it was clear taht strategy was not going to work for this man. He was used to hard work and had alot of personal motivation.

So we worked out a strategy for him to slowly increase his exercise as tolerate, that he might have a sudden heart attack and die, but he was clear that just sitting around doing nothing was unacceptable. So after a few months his exercise tolerance improved from 2 minutes to 20 minutes. He was back on his farm working the fields (at a little slower pace than before) and his ECHO cadiac test showed remarkable improvement, if i remember correctly, up to about 50% function.

So here he was four years later still alive and healthy! so much for fear based medicine. and thank god that some patients actually take it upon themselves to teach us doctors about reality.

aziwa

posted by andru | 5/05/2005 04:50:00 PM | (0) comments |


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