Wednesday, May 1, 2013

Medical & Insurance Providers Gone Too Far??

Normally in the mornings my husband gives me a good morning kiss and heads out the door. I get up from bed, willing or unwillingly, get ready, get the kids up, fix breakfast, then settle down to check out  the news online. I would watch it on TV but that is impossible with Higgly Town Heros on....

Well a couple days ago I ran across an article through the news that really had me upset. Then today "The Stir" did a segment on the same story...it broke my heart and got me angry all in the same breath all over again.

This horrible event happened to Anna and Alex Nikolayev's 5-month-old baby Sammy. Sammy has a heart murmur, which the parents were seeing specialist for.

One day Sammy started developing flu like symptoms in which his parents decided to take him to their current hospital to be seen. Sammy was admitted, but then when he started receiving treatments, the nurses and doctors started making errors. One such was giving him antibiotics which were not needed.

Now, I'm no nurse, but I do have a child who has a medical condition. It's normal for the medical staff to advise and ask for permission to give your child medication. In this case though, from what the mother describes, the hospital did not allow them these simple, procedural, courtesies.

Then the final straw for these parents were when the physicians began talking about heart surgery on this 5 month old. The mother asked for a second opinion but there was some argument for the doctors.

Well, the mother took things into her own hands and took her son without a complete medical release (mistake made), and went directly to another hospital to get the second opinion.

Now I don't condone not following the procedures, but, I also don't condone doctors pressuring parents into surgery unless there are clinical tests and justification for surgery.

Here's where the story gets even worse...Mom and Dad see the second opinion physician and this doctor does everything by the book. Tests, examines, and finds no reason for this poor little guy to go through surgery. You would think this is a happy ending for this stressed parents, but no.

CPS (Child Protection Services) are called in and have police remove this infant from his family.

Now normally when a hospital is involved in medical situations where they believe neglect is apparent they will call CPS to assist with getting the child back for medical reason. Now in this case it's one hospital against the other when it comes to medical necessity for this baby.

CPS is now refusing this couple access to their child and the family has now been thrown into a legal battle.

Now on a personal level I can understand if this baby was not getting the care he needed. I also understand that as a parent with a child who needs special medical care (my 2nd child has craniosynostosis) the hospitals also have to understand and respect my wishes when it comes to the care of my child. If even one mistake was  made during my daughters care, that hospital could kiss my ass because I would go elsewhere in a flash!

But I've also seen other parents and friends with children, who have been bullied by doctors for unnecessary medical treatments.

Between wanting to make money and knowing what's best for a child, sometimes these hospitals, and the insurance companies, are looking at the wrong numbers to make a judgement call. Those numbers aren't PB counts, it's the dollar signs.

It seems crazy, but this isn't the only time I've seen or had someone personally affected by these big medicine thugs. My 43 year old cousin was diagnosed with ovarian cancer almost 9 years ago. She beat it, then developed lung cancer. She beat that one too. After being cancer free for 4 years, she's developed another form of caner which started again in her lungs. The doctors gave her every option they could and finally the cancer was becoming too much for chemo to stop and they recommended a bone marrow treatment. We submitted the claims to her insurance not once but twice! They denied her both times because under their coverage, they couldn't allow her to get the procedure because THEY could not justify the medical necessity. The insurance decided....not her doctors. But without the insurance approval, the procedure could not happen. Her cancer has now spread to her brain. She's now going through harsh radiation to see if they can kill the tumor developing in her brain and praying she makes it to 44.

Now how can this happen? How can we be letting these people gain so much power when they  shouldn't be allowed to make those decisions?

Now some actual good news (but not by much) for these parents though, the judge who resided over this court case gave medical care over to a completely different hospital which had now previous involvement and the parents are being ordered to follow what these physicians advise. However, the still have to get visitations from CPS.

Hopefully it makes them a little more cautious when it comes to the care of their son and .
they won't have to be stuck with CPS forever.

If anything, let this make you smarter and more cautious when you take a loved one into the hospital. Know your rights, research before just telling the doctors to do what they need to do. Also check out your insurance and see how much power you have with them. It might just be a matter of life or death.

Until next time guys and gals...