Is America Burning - a Forum To Discuss Issues

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Skyline - Houston, Texas

Friday, July 20, 2007

This is Outrageous

The same local friend who sent me the cartoon yesterday sent me the following email today.

Evidently some insurance companies will pay only for outpatient care for a mastectomy.

Let's see. You have breast cancer, they lop off a part of your body, and then wave goodbye to you a few hours later? Outrageous. Any surgery is a major assault on the body and recovery takes time. It takes time to make sure infection doesn't set in and that the patient is well enough to understand aftercare instructions.

All of that would apply to any major surgery, not just mastectomy, of course. I don't have any experience with mastectomy but it seems to me that the emotional aftermath for women must be nearly as great if not greater than the physical aftermath. She needs time for healing, counseling, and to gain a little acceptance before she faces being alone.

The bill would make it mandatory for insurance companies to pay for a 48 hour stay.

I checked the Snopes link. Some of the information goes back to 2002 which is evidently how long they've been trying to get this bill through Congress. It was updated in June 2007.

I signed the petition of course but I'm also going to drop a note to my Representative, a "blue dog" Democrat who is rather fiscally conservative (he has to keep his seat in this farming area and the alternative would be far worse) but has a fair to good record on social issues.

I copied and pasted the email. If any of the links don't work, let me know.


Dallas Hodge
Music Website
Mobile: 661-212-1201

Dear friends this only took a minute please sign this petition if you have not already. Pass it on.

PLEASE TAKE THE TIME AND DO THIS.
Thank you for your time!

From a nurse:

I'll never forget the look in my patients ' eyes when I had to tell
them they had to go home with the drains, new exercises and no breast.
I remember begging the Doctors to keep these women in the hospital
longer, only to hear that they would, but their hands were tied by the
insurance companies. So there I sat with my patient giving
them the instructions they needed to take care of themselves,
knowing full well they didn't grasp half of what I was saying, because
the glazed, hopeless, frightened look spoke louder than the quiet
'Thank you' they muttered.

A mastectomy is when a woman's breast is removed in order to remove
cancerous breast cells/tissue. If you know anyone who has had a
mastectomy, you may know that there is a lot of discomfort and pain afterwards.
Insurance companies are trying to make mastectomies an outpatient
procedure. Let's give women the chance to recover properly in the
hospital for 2 days after surgery.

Mastectomy Bill in Congress

It takes 2 seconds to do this and is very important .. .
Please take the time and do it really quick!

Breast Cancer Patient Prtection Act - Important legislation for all women.

Please send this to everyone in your address book. If there was
ever a time when our voices and choices should be heard, this is one of
those times. If you're receiving this, it's because I think you will
take the 30 seconds to go to vote on this issue and send it on to
others you know who will do the same.

There's a bill called the Breast Cancer Patient Protection Act
which will require insurance companies to cover a minimum 48-hour
hospital stay for patients undergoing a mastectomy. It's about
eliminating the 'drive-through mastectomy' where women are forced to go
home just a few hours after surgery, against the wishes of their
doctor, still groggy from anesthesia and sometimes with drainage tubes still attached.

Lifetime Television has put this bill on their Web page with a
petition drive to show your support. Last year over half the House signed on.

PLEASE!! Sign the petition by clicking on the Web site below. You
need not give more than your name and zip code number.

http://www.lifetimetv.com/breastcancer/petition/signpetition.php
COMMENT:
Nvisiblewmn said...
You have got to be kidding me.
Friday, July 20, 2007 11:32:00 AM
ThomasLB said...
You've had a lot of good posts lately!I would add that signing the petition is only a start. That should be followed up with letters to representativs and senators, and maybe the local newspapers.
Saturday, July 21, 2007 7:19:00 AM
Sometimes Saintly Nick said...

I signed the petition, but, having worked for an insurance company I fear that legislation will be needed to make changes because, unfortunately, that’s the way insurance companies work. I fear it is going to take laws to end it. It the same way with many procedures: like giving birth (“the kid’s born; you go home”).

When I had my gall bladder removed it was supposed to have been an out patient procedure. I was surprised to awaken from the anesthetic in ICU. They didn’t send me home because some problem developed while I was anesthetized and the gas pusher fears I might croak. I don’t know how my insurance carrier reacted to paying for an over night stay in the ICU.

Saturday, July 21, 2007 10:27:00 PM

WA: Probably gave the hospital a huge hassle and made the surgeon "prove" it was necessary by submitting complete and detailed records of the surgery, etc.

Kvatch said...

The bill would make it mandatory for insurance companies to pay for a 48 hour stay.

I'm sorry. This bill may be a step in the right direction, but it may also end up just as bad as the insurance company deciding on how long one stays in the hospital (or not) after a radical mastectomy.

The fundamental issue is not the length of the stay because if you legislate 48 hours, then insurance companies will just come back and say "OK ya got 48 hours no matter how serious your complications are". Having legislators decide the issue is just as bad as having insurance adjusters decide the issue.

There is one, and only one person, who should be making such a decision, the doctor. Insurance companies have a job. It's to decide how to set rates so that doctors can do their job in deciding the length of care. The legislator's job, such that they have one is to ensure that doctor's are allowed to give the best care possible.

I'd much prefer to see a bill that untether's the doctors.

Sunday, July 22, 2007 1:54:00 PM


Granny said...

Kvatch and Nick, you'll get no argument from me.

I was a little reluctant to even single out mastectomy because I'm sure the "drive-through" is common to much surgery these days.

I haven't read the law but certainly if a person, for whatever surgery and whatever reason, needs more than 48 hours they should have it.

And we shouldn't need laws to do the right thing with any medical care.

Sunday, July 22, 2007 2:17:00 PM

WA: Kvatch and Granny:100% correct, but this admin especially caters to business' profit margin and NOT to the welfare of citizens.
Worried said...

And "drive-thru" deliveries - enter the hospital, squirt out the kid then go home. Insurance companies dictate the length of stay for normal deliveries, regardless of varying pre- or post partum conditions. Also, due to insurance restrictions and rising costs, many hospitals opted to maintain a skeleton OB/GYN staff and call in "floaters" if the patient load becomes heavy. A floater is a licensed nurse registered with an agency who will send out a warm body to a hospital when needed, regardless of her qualifications. She need not have but little or no experience in Obstetrics since her classes in nursing school. She is merely a warm body to fill a staffing slot, so for X number of in-labor patients the hospital has Y number of nursing personnel for the moment.

Our family OB/GYN physician was not one of those doctors who schedule an early C-Section because he has a vacation planned for the due date of a patient. He would not subject a patient to the risks of major surgery unless it was medically indicated. My youngest daughter had certain conditions that led him to believe that a C-Section might be necessary. BUT the insurance company dictated that a patient must be allowed to try to deliver normally before they would pay for a C-Section, even though procedures followed during labor increase the risk of post-partum infection if a C-Section becomes necessary.

When she went into premature labor, the nurse (Nurse? Hah!!) was a floater and apparently had no idea what she was feeling of when she manually checked for cervical dilation. Furthermore, she seemed to have no idea how much bleeding was normal during labor and just kept cramming towels under my daughter to soak up the excessive bleeding. And last but not least, seemed not to have the vaguest notion how to read the signals of the fetal monitor. In hard labor after many hours that night, my daughter stated that her pains were worse than when she had the kidney stone. The nurse scoffed at her and derided her complaint by saying those were just "little baby pains; she was only 3 cm. dilated." (Dilitation of 10 cms. is necessary for delivery). She shamed my daughter and made her feel like a wimp and a cry-baby. She ignored my daughter's anxious warning that the fetal monitor was showing fetal distress; after all SHE was the PROFESSIONAL and my daughter was only a lay person.

When the doctor came in for early morning rounds, the nurse reported only a 3 cm. dilation and went off duty. The first thing the doctor said when examining my daughter was an alarmed "she's bleeding too much!" and the second was that she was a complete 10 cms. dilated, and the third was that the baby was floating high in the uterus (not engaged in the pelvic cavity) and was in acute distress. In fact, meconium (baby stools) was passing from the birth canal, a sign of fetal distress besides the beeping fetal monitor. My daughter's and the baby's conditions indicated a need for an emergency C-Section but there was no time to set up for it.
(Another foul up; the doctor had ordered that preparations be in place in case of an emergency C-Section, which was ignored). The doctor had to manually push the baby down and extract it with forceps. The baby was tangled in the umbilical cord, his entire head looked like a purple plum and he appeared dead, a horrible shock to my daughter when the doctor flopped him on her belly as he strove to stem her hemorrhaging.

Both she and the baby survived but since she had had a "normal" delivery, the insurance company refused to pay for a continued hospital stay, refused to pay for the badly needed blood transfusions but since the baby was a preemie and in bad shape, they did graciously agree to pay for his neo-natal preemie ICU. And ofcourse they refused to pay for therapy to treat her severe post-partum depression as that condition is "normal"also. I called it PostTraumaticStressDisorder due to the horrors she experienced during labor and delivery.

Oh yes, they also agreed to pay for the post-partum surgical repairs and hysterectomy necessitated by the complications during labor and delivery, which effectively limited her to one child.

All of which cost the dorks more in the long run than it would have cost them IF they had allowed the doctor to make the call and perform a C-Section in the first place. It would have saved my daughter months of acute depression and emotional stress, and saved her baby several years of certain complications. Plus it robbed her and her husband of the bonding joys of delivering their first (and only) child.

Insurance bean-counters should NOT be allowed to dictate patient care.

Sunday, July 22, 2007 6:07:00 PM

Labels:

6 Comments:

  • At Friday, July 20, 2007 11:32:00 AM , Blogger Nvisiblewmn said...

    You have got to be kidding me.

     
  • At Saturday, July 21, 2007 7:19:00 AM , Blogger ThomasLB said...

    You've had a lot of good posts lately!

    I would add that signing the petition is only a start. That should be followed up with letters to representativs and senators, and maybe the local newspapers.

     
  • At Saturday, July 21, 2007 10:27:00 PM , Blogger Sometimes Saintly Nick said...

    I signed the petition, but, having worked for an insurance company I fear that legislation will be needed to make changes because, unfortunately, that’s the way insurance companies work. I fear it is going to take laws to end it. It the same way with many procedures: like giving birth (“the kid’s born; you go home”).

    When I had my gall bladder removed it was supposed to have been an out patient procedure. I was surprised to awaken from the anesthetic in ICU. They didn’t send me home because some problem developed while I was anesthetized and the gas pusher fears I might croak. I don’t know how my insurance carrier reacted to paying for an over night stay in the ICU.

     
  • At Sunday, July 22, 2007 1:54:00 PM , Blogger Kvatch said...

    The bill would make it mandatory for insurance companies to pay for a 48 hour stay.

    I'm sorry. This bill may be a step in the right direction, but it may also end up just as bad as the insurance company deciding on how long one stays in the hospital (or not) after a radical mastectomy.

    The fundamental issue is not the length of the stay because if you legislate 48 hours, then insurance companies will just come back and say "OK ya got 48 hours no matter how serious your complications are". Having legislators decide the issue is just as bad as having insurance adjusters decide the issue.

    There is one, and only one person, who should be making such a decision, the doctor. Insurance companies have a job. It's to decide how to set rates so that doctors can do their job in deciding the length of care. The legislator's job, such that they have one is to ensure that doctor's are allowed to give the best care possible.

    I'd much prefer to see a bill that untether's the doctors.

     
  • At Sunday, July 22, 2007 2:17:00 PM , Blogger Granny said...

    Kvatch and Nick, you'll get no argument from me.

    I was a little reluctant to even single out mastectomy because I'm sure the "drive-through" is common to much surgery these days.

    I haven't read the law but certainly if a person, for whatever surgery and whatever reason, needs more than 48 hours they should have it.

    And we shouldn't need laws to do the right thing with any medical care.

     
  • At Sunday, July 22, 2007 6:07:00 PM , Blogger Worried said...

    And "drive-thru" deliveries - enter the hospital, squirt out the kid then go home. Insurance companies dictate the length of stay for normal deliveries, regardless of varying pre- or post partum conditions. Also, due to insurance restrictions and rising costs, many hospitals opted to maintain a skeleton OB/GYN staff and call in "floaters" if the patient load becomes heavy. A floater is a licensed nurse registered with an agency who will send out a warm body to a hospital when needed, regardless of her qualifications. She need not have but little or no experience in Obstetrics since her classes in nursing school. She is merely a warm body to fill a staffing slot, so for X number of in-labor patients the hospital has Y number of nursing personnel for the moment.

    Our family OB/GYN physician was not one of those doctors who schedule an early C-Section because he has a vacation planned for the due date of a patient. He would not subject a patient to the risks of major surgery unless it was medically indicated. My youngest daughter had certain conditions that led him to believe that a C-Section might be necessary. BUT the insurance company dictated that a patient must be allowed to try to deliver normally before they would pay for a C-Section, even though procedures followed during labor increase the risk of post-partum infection if a C-Section becomes necessary.

    When she went into premature labor, the nurse (Nurse? Hah!!) was a floater and apparently had no idea what she was feeling of when she manually checked for cervical dilation. Furthermore, she seemed to have no idea how much bleeding was normal during labor and just kept cramming towels under my daughter to soak up the excessive bleeding. And last but not least, seemed not to have the vaguest notion how to read the signals of the fetal monitor. In hard labor after many hours that night, my daughter stated that her pains were worse than when she had the kidney stone. The nurse scoffed at her and derided her complaint by saying those were just "little baby pains; she was only 3 cm. dilated." (Dilitation of 10 cms. is necessary for delivery). She shamed my daughter and made her feel like a wimp and a cry-baby. She ignored my daughter's anxious warning that the fetal monitor was showing fetal distress; after all SHE was the PROFESSIONAL and my daughter was only a lay person.

    When the doctor came in for early morning rounds, the nurse reported only a 3 cm. dilation and went off duty. The first thing the doctor said when examining my daughter was an alarmed "she's bleeding too much!" and the second was that she was a complete 10 cms. dilated, and the third was that the baby was floating high in the uterus (not engaged in the pelvic cavity) and was in acute distress. In fact, meconium (baby stools) was passing from the birth canal, a sign of fetal distress besides the beeping fetal monitor. My daughter's and the baby's conditions indicated a need for an emergency C-Section but there was no time to set up for it.
    (Another foul up; the doctor had ordered that preparations be in place in case of an emergency C-Section, which was ignored). The doctor had to manually push the baby down and extract it with forceps. The baby was tangled in the umbilical cord, his entire head looked like a purple plum and he appeared dead, a horrible shock to my daughter when the doctor flopped him on her belly as he strove to stem her hemorrhaging.

    Both she and the baby survived but since she had had a "normal" delivery, the insurance company refused to pay for a continued hospital stay, refused to pay for the badly needed blood transfusions but since the baby was a preemie and in bad shape, they did graciously agree to pay for his neo-natal preemie ICU. And ofcourse they refused to pay for therapy to treat her severe post-partum depression as that condition is "normal"also. I called it PostTraumaticStressDisorder due to the horrors she experienced during labor and delivery.

    Oh yes, they also agreed to pay for the post-partum surgical repairs and hysterectomy necessitated by the complications during labor and delivery, which effectively limited her to one child.

    All of which cost the dorks more in the long run than it would have cost them IF they had allowed the doctor to make the call and perform a C-Section in the first place. It would have saved my daughter months of acute depression and emotional stress, and saved her baby several years of certain complications. Plus it robbed her and her husband of the bonding joys of delivering their first (and only) child.

    Insurance bean-counters should NOT be allowed to dictate patient care.

     

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