In his documentary Sicko, director Michael Moore includes a “confession” by a long-time Health Maintenance Organization (HMO) physician, who was speaking before Congress.
“My name is Linda Peeno,” she began. “I am here primarily today to make a public confession: In the Spring of 1987, as a physician, I denied a man a necessary operation that would have saved his life, and thus caused his death.
“No person and no group has held me accountable for this because, in fact, what I did was I saved a company a half a million dollars… And furthermore, this particular act secured my reputation as a good medical director, and it insured my continued advancement in the healthcare field. I went from making a few hundred dollars a week as a medical reviewer to an escalating six-figure income as a physician executive.
“In all my work, I had one primary duty, and that was to use my medical expertise for the financial benefit of the organization for which I worked. And I was told repeatedly that I was not denying care; I was simply denying payment.”
Throughout the United States, as Moore’s film reveals, such stratagems pervade health insurers’ medical decisions and are evident in the way health-insurance policies are written. Here’s one patient’s experience with Kaiser Permanente, a not-for-profit health plan insuring 8.6 million members. Its website reports revenues last year topped $40 billion.
Linda Petersen, ad manager of The West Marin Citizen, suffered 11 broken ribs, two broken vertebrae, two broken ankles, a broken leg, a broken kneecap, a broken arm, and a punctured lung when she fell asleep at the wheel June 13 and hit a utility pole in Inverness. This week she had another disastrous collision, this time with her Kaiser Permanente medical-insurance policy.
“It’s kind of insane,” she told me Thursday when I visited her at The Rafael: Assistance for Living, a convalescent hospital in San Rafael. “Having health insurance doesn’t mean you’ll be covered.”
Linda, as can be seen in the photo, still wears casts on both legs and her left arm. Her head and neck are immobilized by a steel-and-carbon “halo.” Although she remains physically helpless, Kaiser told her yesterday her hospitalization costs will not be covered after next week until she’s ready for more-advanced physical therapy.
What’s the rationale for stopping coverage? “A Kaiser representative said I was fulfilling the physical-therapy goals by being able to transfer to a wheelchair,” Linda explained. “They’re looking for all these bureaucratic excuses.”
It’s not that she can get into a wheelchair on her own, mind you. It takes a physical therapist to carefully lift her to the edge of the bed, help her balance and pivot on her right foot (which isn’t as badly broken as her left), and then seat her in the chair. Once she’s in it, all she can do is sit, which she does for an hour a day.
Kaiser yesterday told Linda that next week the lower-paid staff at The Rafael will be trained so that one of them can take over from the two therapists who have been moving her.
This may be penny wise and pound foolish since moving her requires expertise; on Friday, after this posting originally went online, a skilled therapist lost his grip while moving her, and she had to catch herself by standing on her broken left leg and shattered ankle. Now she can barely move the leg, which had begun to heal.
The Rafael, Linda explained, is one of three hospitals in Marin County with which Kaiser has convalescent-care contracts. “I have no option to go anywhere else,” Linda said, and “I can’t be kicked out.” But starting a week from now, she’ll have to pay The Rafael $1,750 per week for at least the next month.
Linda with her elderly dog Sebastian who died in the crash.
“After next week,” Linda said, “Kaiser won’t cover anything until the doctor says I can put more weight on my weight-bearing extremities [e.g. the foot the physical therapist dropped her on]. It’s a matter of what the fine print says in the insurance contract.” Linda, who got her Kaiser policy through her job, noted, “You don’t sit down and read all of it.” Nor would it make any difference if you did.
“I felt shocked that they could stand there, when I’m totally helpless, and say I’m not going to be covered,” Linda remarked. “But it’s become general knowledge that’s how healthcare works in this country. It’s mind boggling to me that anyone would vote against universal healthcare.
“As a patient, you’re confronted in a very vulnerable situation. It’s horrible. I was crying this morning. They threw me into turmoil. I don’t know how long I’m going to be here. I don’t know how much it will cost.”
“But I can’t sit here and agonize over it,” she added, and, putting on a smile, began poring over today’s issue of The Citizen.
This week I saw a wild turkey scare off a young deer on this hill by flapping its wings, and I’ve previously seen horses having fun chasing turkeys around in the Giacomini family’s pasture next to mine.
The fawns appear healthy and are now old enough to enjoy bounding across my fields. I see them as a good omen for this summer.
The advertising manager of The West Marin Citizen, Linda Petersen, 61, of Inverness, suffered major injuries last night around midnight when her car hit a utility pole just west of Motel Inverness.
The good ship Mary Kay’s Revenge from Marshall. The Point Reyes Light on Thursday reported, “The boat is constructed largely of recycled sail cloth, plywood and pallets” and had been sitting “on Peggy Bannan’s porch in Reynold’s Cove” while awaiting the parade.
Western Weekend Queen Mindy Borello, 17, rode in a pickup-truck carriage during Sunday’s parade. Mindy won the queen contest by selling the most Western Weekend raffle tickets.
Western Weekend Princess Rocio Gomez Together Rocio and Mindy sold more than $8,000 worth of raffle tickets.
Three quarters of a century Inverness Garden Club’s entry each year includes numerous participants, a motorcycle with a sidecar, and a float festooned with flowers and greenery. This year the club is celebrating its 75th anniversary, hence the birthday cake. Among the club’s activities is maintaining flower beds in public places.
Several kids on mini-motorcycles took part in the parade. This young biker may be new to the parade circuit, but he has already learned its protocol. To get the attention of other kids along the parade route carry a bag of candies and toss out handfuls. Works every time.
West Marin School students dance a Paso Durangeneze. The group includes Alejandro Chavarria, 3rd grade; Graciela Avalos, Sarahisabel Barajaz, Stepanie Gonzalez, William Gonzalez, Shelby Hunt, Normar Isais, Bianca Lima, and Phoebe Marshall, 4th graders; and Armando Gonzalez, 5th grade. Their teacher is Dolores Gonzalez.
The Nave Patrola annually spoofs the Italian Army in World War I although it also borrows an “Il Duce” chant from World War II.
Thoroughly enjoying the livestock show were the dogs of Lisa Patsel, who owns Tree House bed-and-breakfast inn.
Michelle McClure took first place in senior showmanship for Holstein cows, and Nathan Hemett took second.
Freddie Genazzi’s red slider named Ozzie took first place in the turtle competition. Although his sister wasn’t present, her turtle, whom the judge dubbed Harriet, took second.
Judges Ellie Genazzi and Terry Gray compare notes during the Western Weekend Fair’s dog show.
While the obstacle course confused all the dogs that went on it, this Dumpster behind the Dance Palace confused virtually all the humans who went to use it.
In subsequent years, the event increasingly focused on 4-H and FFA (Future Farmers of America).
The Wells Fargo stagecoach in last year’s parade.
While driving on Novato Boulevard between Hicks Valley and Stafford Lake, Anika was startled to see a purple couch abandoned on the shoulder of the road. (Since then I’ve heard from others who also saw it and were likewise surprised.)
