Friday, June 04, 2004
The Case of the Escrowed Skull
For the benefit of those who may not have seen it, I pass along the following, which was kindly forwarded to me by Jeff Frommelt.
After trying to think of something clever to say about it, I decided to let the story speak for itself.
……………………………..
By Alexandria Sage
Associated Press
Published May 14, 2004
MIDVALE, Utah -- After a lot of red tape, Briana Lane has her skull back in one piece.
The 22-year-old woman was injured in an auto accident in January, and doctors temporarily removed nearly half her skull to save her life.
For nearly four months afterward, however, the piece of bone lay in a hospital freezer across town because of a standoff with Medicaid and the hospital over who would cover the surgery to make her whole again.
The surgery finally came through after an excruciating wait, during which she suffered extreme pain just bending down and would wake up in the morning to find her brain had shifted to one side during the night.
"When you think of weird things happening to people you don't think of that," Lane said. "It's like taking out someone's heart--you need that."
Sonya Schwartz, a health-policy analyst for Families USA, a consumer health-care group, said insurance horror stories happen every day but "this particular story is outlandish."
On Jan. 10, Lane's car rolled over on an icy canyon road above Salt Lake City. Lane, who was not wearing a seat belt, was thrown through the windshield. She later was charged with driving under the influence and not having a driver's license.
Doctors at the University of Utah Health Sciences Center in Salt Lake City removed the left side of her skull to treat bleeding on her brain. Lane's doctor originally scheduled the replacement surgery for mid-March, a month after her release from the hospital, said her mother, Margaret McKinney, a nurse who works in another division of the medical center.
But the operation was canceled the night before because the hospital was waiting to see whether Medicaid would cover it--a process that can take at least 90 days.
Lane, a waitress with no insurance, was sent home from the hospital with a big dent in her head where the bone had been removed but the scalp had been sewn back into place. She stayed home, able to walk around but not go to work, and had to wear a plastic street-hockey helmet during the day.
During the wait for a decision from Medicaid, the hospital could have declared an emergency, moved ahead with the surgery and figured out afterward who would pay--the hospital, Medicaid or the patient. But the hospital did not do so.
Lane's mother said she argued with the hospital: "We just want what you've taken away. Can you just give us back the skull and we'll go on with our lives?"
After months of delay, Lane contacted a local television station, a move she thinks hastened the surgery. The operation took place April 30.
Exactly what broke the impasse is unclear.
The operation took place after Lane's mother's insurance decided to cover the surgery, as well as her nearly $200,000 in medical bills.
A hospital spokeswoman though refusing to comment on certain specifics of Lane's case because of federal privacy rules, said the medical center decided to go forward with the surgery before it learned the insurance would pay.
Utah's Medicaid program has yet to decide whether Lane qualifies.
Robert Knudson, director of eligibility services at the Utah Health Department, which oversees Medicaid, said the agency has not yet seen enough evidence to decide whether her injuries entitle her to benefits under the law.
He would not comment on whether her four-month wait was unreasonable. He said the decision over how fast Lane should have received treatment was up to the doctors, not Medicaid.
Dr. Ronald Young, a neurosurgeon at St. Vincent Indianapolis Hospital, said such surgery would not be considered an emergency but typically is performed within three to four weeks, after swelling has gone down, because the risks to the patient are high.
"There's no reason not to replace that as soon as you can," Young said. "I don't like to have people who are walking not have their skull."
He added: "For a person who is walking, who is ambulatory, to not have their skull is a problem because you get a lot of brain shift. A simple fall, hitting her head or something could be horrendous."
Today, Lane finds that performing simple tasks is no longer excruciatingly painful, but she said the experience has left her more cynical about the health-care system.
"Just because [patients] don't have money doesn't mean they should be treated differently from anyone else," she said. "I'm a good person. I just happen to be not as rich as some of them."
Copyright © 2004, Chicago Tribune
For the benefit of those who may not have seen it, I pass along the following, which was kindly forwarded to me by Jeff Frommelt.
After trying to think of something clever to say about it, I decided to let the story speak for itself.
……………………………..
By Alexandria Sage
Associated Press
Published May 14, 2004
MIDVALE, Utah -- After a lot of red tape, Briana Lane has her skull back in one piece.
The 22-year-old woman was injured in an auto accident in January, and doctors temporarily removed nearly half her skull to save her life.
For nearly four months afterward, however, the piece of bone lay in a hospital freezer across town because of a standoff with Medicaid and the hospital over who would cover the surgery to make her whole again.
The surgery finally came through after an excruciating wait, during which she suffered extreme pain just bending down and would wake up in the morning to find her brain had shifted to one side during the night.
"When you think of weird things happening to people you don't think of that," Lane said. "It's like taking out someone's heart--you need that."
Sonya Schwartz, a health-policy analyst for Families USA, a consumer health-care group, said insurance horror stories happen every day but "this particular story is outlandish."
On Jan. 10, Lane's car rolled over on an icy canyon road above Salt Lake City. Lane, who was not wearing a seat belt, was thrown through the windshield. She later was charged with driving under the influence and not having a driver's license.
Doctors at the University of Utah Health Sciences Center in Salt Lake City removed the left side of her skull to treat bleeding on her brain. Lane's doctor originally scheduled the replacement surgery for mid-March, a month after her release from the hospital, said her mother, Margaret McKinney, a nurse who works in another division of the medical center.
But the operation was canceled the night before because the hospital was waiting to see whether Medicaid would cover it--a process that can take at least 90 days.
Lane, a waitress with no insurance, was sent home from the hospital with a big dent in her head where the bone had been removed but the scalp had been sewn back into place. She stayed home, able to walk around but not go to work, and had to wear a plastic street-hockey helmet during the day.
During the wait for a decision from Medicaid, the hospital could have declared an emergency, moved ahead with the surgery and figured out afterward who would pay--the hospital, Medicaid or the patient. But the hospital did not do so.
Lane's mother said she argued with the hospital: "We just want what you've taken away. Can you just give us back the skull and we'll go on with our lives?"
After months of delay, Lane contacted a local television station, a move she thinks hastened the surgery. The operation took place April 30.
Exactly what broke the impasse is unclear.
The operation took place after Lane's mother's insurance decided to cover the surgery, as well as her nearly $200,000 in medical bills.
A hospital spokeswoman though refusing to comment on certain specifics of Lane's case because of federal privacy rules, said the medical center decided to go forward with the surgery before it learned the insurance would pay.
Utah's Medicaid program has yet to decide whether Lane qualifies.
Robert Knudson, director of eligibility services at the Utah Health Department, which oversees Medicaid, said the agency has not yet seen enough evidence to decide whether her injuries entitle her to benefits under the law.
He would not comment on whether her four-month wait was unreasonable. He said the decision over how fast Lane should have received treatment was up to the doctors, not Medicaid.
Dr. Ronald Young, a neurosurgeon at St. Vincent Indianapolis Hospital, said such surgery would not be considered an emergency but typically is performed within three to four weeks, after swelling has gone down, because the risks to the patient are high.
"There's no reason not to replace that as soon as you can," Young said. "I don't like to have people who are walking not have their skull."
He added: "For a person who is walking, who is ambulatory, to not have their skull is a problem because you get a lot of brain shift. A simple fall, hitting her head or something could be horrendous."
Today, Lane finds that performing simple tasks is no longer excruciatingly painful, but she said the experience has left her more cynical about the health-care system.
"Just because [patients] don't have money doesn't mean they should be treated differently from anyone else," she said. "I'm a good person. I just happen to be not as rich as some of them."
Copyright © 2004, Chicago Tribune
