Friday, August 12, 2011

NC Medicaid : 'You've got MRSA and All We Can Offer You Is Someone To Help You Take Your Bath": Haywood Regional Medical Center On The Skids

There's a fight to the death here and it's being identified by the New York Times (NYT). Yeah, literally to the death. See:

People with 'proper health insurance' would never be serially dismissed from regional hospitals on the basis of "you seem good enough now.....guess you should go on home where you'll be 'more comfortable.'" It is frankly galling to see this level of lack of care and homilies when really the matter should be (may be?) reported to the hospital accreditation agency, JACHO (the accrediation agency for hospitals).

And so, more specific to the matter at hand, today I spoke w/ my client who is in Haywood Regional Medical Center. I visited that client day before yesterday in the hospital (psychologists cannot be paid for work done in hospitals unless they are on staff which is mostly unheard of). I am a clinical / health psychologist and boy do I know more than I need to know about hospital procedures. Need to get your pain medication actually given to you on time? Call on your hospital room or cell phone to the nursing supervisor who will put a hurt on the nurse that can't find time to give you the pain med.

The client is in a room with cap/ gown/ mask procedures. Cellulitis post surgical is now spreading up the fascia of the client's belly indicating that the bacterial infection has not been bought under appropriate control. Imagine a million microbes chewing your flesh, from the inside out. Think you'd hurt?

If the client had been in a charity hospital (the ones that take good care of everyone, such as Grady Hospital in Atlanta), the client would have been isolated and given appropriate care for such an infection. But hey, this is a 'MedWest' private hospital in western NC. On the other hand, those hospitals have been going broke for a long time due to the severity of illnesses of their patients that no other hospital will touch.

The client had surgery at Harris Regional Medical Center in Sylva, NC; 'got' MRSA (Methecillin Resistant Staphylococcus Aurea as associated with said surgery. This is a very, very serious infectious disease running rampant amongst hospitals). One assumes that the Infectious Disease nurse/ department at that hospital was advised that their operating theatre is perhaps passing on this deadly bacteria but who knows give the lack of communication amongst medical personnel and institutions. This being said, I'd wager a bet that JACHO would be interested in the matter, for whatever that's worth.

This is, of itself, amazing. A major hospital in western NC is spreading MRSA or so it appears. Hospitals, contrary to what the human eye believes it can see, are the filthiest places on the planet.

The client has extreme pain related to the surgical incision which client describes as leaking through bandages "like the Texas Chainsaw Massacre." It should be malpractice that this is allowed to take place. It should be malpractice that the client is not given sufficient pain relief prior to wound dressing taking place.

It does not matter that this is a person in 'physical' pain though they also have an overlapping mental health challenge. Pain is pain. Interestingly, when this psychologist strongly recommended to the Harris Hospital nursing supervisor that the client 'not go home after two days of major surgery' this was summarily dismissed. The client was actually queried as to whether it would be useful to go a psychiatric unit. Duh, no. The client was not experiencing a mental health challenge; the client had just had surgery and Medicaid had, apparently, no capacity to appreciate the severity of the surgery .

That's NC Medicaid for ya. They must really recoup some money when a re-admission takes place and the patient sits in the ER for about a dozen hours at some amazing rate charged to Medicaid.

So, there's no money saved; there's just the illusion of savings. And heck, did I tell you that someone will lose their life over these silly administrative parryings?

More recently, as per this current visit at Haywood Regional Hospital, and as per a social worker, assumably from Haywood Regional Medical Center, the Medicaid client has been advised that the 'only services' available to this MRSA----very contagious medical illness but we are still going to get you out of the hospital------are 'probably associated with someone to come over to the house to help you with your shower and getting dressed.' I have to wonder how the client's 4 children will cope with this matter. Will THEY get infected?

The person to be assigned to the 'bathing and dressing' obviously would not be a trained individual associated with 'wound care' such that the MRSA matter is addressed in a systematic manner.

Imagine the dismay you might experience if the hospitalist walked it your room and said, 'Have you ever heard of MRSA?' The client used an available cell phone to take pictures of the incision and was scared to death as research indicated on the cell phone what the seriousness of the matter was.

What happens when you get a MRSA infection? You commonly die a long, prolonged death associated with pain and septicemia (the bacteria overwhelms your immune system). You can bet that that the hospital has a keen desire to 'get rid of' the client as quickly as possible prior to such a scenario taking place. Nevermind that the person will be back pretty soon...with a life-threatening septicemia sure to take a life. Is it treatable? Sure, if you have enough money or health insurance. Even if you're a dually insured Medicare/ Medicaid client.

But heck, Medicaid clients have no recourse to asking for appropriate services and that is what the case moving towards the US Supreme Court is about. The NYT stays on the story (their banner states: "All the News That's Fit To Print")

"A Scalpel, Not an Ax, for Medicaid

....Medicaid is one of their (states') biggest, fastest-growing expenses. The risk is that injudicious cuts could harm their most vulnerable citizens....It should not be particularly hard for any state to demostrate that it cosidered all the facors mandated by law---not just access, but effects on quality and effiency as well----in making necessary cuts to Medicaid spending...."

"....Something's happening here.....what it is ain't exactly clear...." (Buffalo Springfield)

Tuesday, August 09, 2011

'Democrats Challenging (Obama) Administration on Medicaid: Gee, Where Have I Heard This Kind of Non-transparency Before....: Federal Lawsuit

Western Highlands Network (WHN) LME, which oversees public mental health (Medicaid) in many western NC counties, including Buncombe County where Asheville, NC is, has a board which recently had its hand forced in terms of kowtowing to a 'Non Disclosure Agreement' hoisted by another LME (and anchored into place by NC DHHS). That 'Non Disclosure' Agreement forbids disclosure of language associated with behind-the-scenes contract agreements which blocks consumers e.g., Medicaid clients, from being able to potentially obtain medical records and information barring their access to services.

THAT was the big deal as associated with the June and July meetings of the Western Highlands Network LME Board meetings (the board cancelled their August, 2011 meeting, for unknown reasons).

This recent move by the Obama administration to block Mediciaid consumers from suing the government for denial of services is similar in its thrust as pertaining to the issue of blocking Medicaid clients from obtaining information about denial of services.

Today's New York Times (NYT) featured an article outlining how the Obama administration (didn't we elect a Democrat?) ".....maintains that beneficiaries and health care professionals cannot sue state officials to challenge cuts in Medicaid payment rates, even if such cuts compromise access to care for the poor...In a friend-of-the-court brief, the lawmakers said the administration's position 'would undermine the effectiveness of Medicaid'. In addition, they said, it conflicts with MORE THAN A CENTURY of court precedents that allow people to sue to block state actions that are inconsistent with federal law.....The issue, of immense importance to poor people and states, comes to the Supreme Court in a set of cases consolidated under the name of Douglas v. Independent Learning Center of Southern California, No 09-958." (see:

The 'denial of services' is at the heart of how consumers/ clients will and do interface with entities such as WHN LME or any other LME in NC that controls funding to Medicaid mental health services. Simply put, the Non Disclosure Agreement which WHN LME Board was forced to accept and this stance by the Obama administration are twin doppelganger reflections of a government that refuses to be transparent to the people who fund it: the taxpayers. (see:

As iconoclastic journalist, I.F. Stone ("Izzy") stated: "Its bad enough just to have a government."

Tuesday, August 02, 2011

"The Doctor Will See You.....Eventually" : the Wait Time for Resolving Medication Issues for Daymark Recovery Psychiatric Patients in Western NC

The American Psychological Association has a Code of Ethics which psychologists are supposed to abide by. Its not just a professional organization so much as it is a guide-post for practice. Beyond that, however, I attempt to 'treat others as I would be treated' and frankly this seems like a good rule of thumb.

For over the past 28 hours, I have used up about two hours doing the following in an attempt to get an answer for the re-fill of a prescription for a client of mine that has been in place for about the past year and a half. The medication is Clonidine which doubled as an anti-hypertensive and more and more commonly, treatment for PTSD. It's not a controlled substance. I am now, as in the past, less well liked, as a professional and in general, that I was about a day ago.

The client ran into a debacle as regards the refill as the medication was, a few months ago, stolen from the trailer where the client lives, assumably because it has the appearance of a narcotic medication and boy, they are all the rage in terms of consumables in western NC. You can make a lot of money if you're poor, selling some pills.

The medical record of the company apparently did not reveal that the psychiatrist had 'reset' the time for writing the prescription due to that episode or at least that is what the executive of the company, whom had access to the medical records, inferred. Other than that small piece of information, I cannot understand why this became the boondoggle it did and why the client continues, even this evening, to suffer due to the lack of medication. It would do no good to go the ER as the client would not be given what is appropriate (if you're a betting person, contact me and we can bet on that).

And as times becomes more and more desperate, the selling of pills happens more and more frequently. I can't tell you how many times I have had clients whom left a window open, left a window unlocked, had someone knock down the door of their trailer, or left out their purse, or generally did not guard with their lives their medication.

The client is treated by a psychiatrist at Daymark Recovery whose base is in eastern NC. They have a contract via Appalachian Counseling to offer telemedicine at The Balsam Center in Waynesville, NC, where I have quite a few clients.

I practice as a clinical / health psychologist (my PhD was in that arena) and I not infrequently engage with physicians and physician extenders (PA's or nurse practitioners) re: medication issues or health issues. Indeed, one of the agendas of newer legislation regarding mental health care is to 'wrap around' to physicians and physician extenders in order that we all be on the same page. Trying to stay in touch w/ other providers is the most difficult part of my job. I write letters, usually cc'd to the client; I make telephone calls; in general, if necessary, I harass----the medical providers in order to get the job done for the client.

I was for many years a registered respiratory therapist working in ICU's and ER's of large city hospitals. I know my western medicine.

And so, it is troubling to me to find that regardless of my efforts----and they are an extensive bombardment inclusive of phone calling, e mailing, texting, etc.,----that I could not----after 4 text messages, one phone call when I talked to the psychiatrist, and numerous voice mails left for an executive of the company----resolve the problem of this rural client of mine, whom I have seen for several years. I even sent the executive the name and date of birth of the client to his specific e mail in order to try and get something done as I could turn no one up to help w/ the situation. This is perhaps not in keeping w/ HIPAA but given the APA Code of Ethics, it seems to me that I had best attend to the APA Code of Ethics regarding the treatment of others whom are my clients. I could not, in good conscience, dabble and make a few non-tethered calls----until I finally came to the conclusion----which I discussed with the client-----that I could not make an impact.

The client works hard to try and stabilize physical health issues. It is very sad and maddening to see how little impact I can have on the very large Daymark Recovery system re: my rural client, calling and calling----again and again to the local pharmacy----to the point that the client gave up as there are numerous medications they fill for said client and enraging the pharmacy was not something that was wise to do. We understand they are busy; however there is no efficient system for knowing if the script has been filled or not.

Lo and behold, the NYT has today in the Science Section an article about just that: "The Doctor Will See You....Eventually." ".....Nationwide, the average wait time to see a doctor last year was 23 minutes, according to the health care consultants Press Ganey." (I wonder what the wait time is to get an answer over the phone, however). See the article here:

I am sorry to have perturbed the executive of the company but my allegiance is to the client and not to the extended provider network that throws up its hand when it hits the wall of not being able to get the prescriber to address the issue.

You need a new prescriber, I told the client. The issue is this, however: there are so few psychiatric providers in rural western NC. Pick your poison, I suggested.

Monday, August 01, 2011

NC Med.Journal: Hlth Reform: by 2014,20% state's population on Medicaid : Lanier Cansler, Secretary NC DHHS Speaks Out

The March/ April 2011 NC Medical Journal has an interesting article by Secretary of NC DHHS, Lanier Cansler.

In about 3 years, 20% of the population of NC will be on Medicaid. Isn't it time to have a One Provider System? There's no sign of that taking place, however, re: the 'exchange' which Mr. Cansler described in his article:

Some timely comments from Mr Cansler's article in this public policy medical journal for the state:

"....NC Medicaid (will cover).....more than 20 million individuals, or approximatley 20% of the state's population by 2014. Beginning in 2014, all legal residents younger than 65 years whose income falls at or below 138% of the federal poverty level will be eligible for Medicaid coverage....

One key provision of the ACA (Affordable Care Act) is the requirement that states establish a 'no wrong door' approach fo individuals seeking to learn whether they are eligible or want to apply for a health insurance exchange product.....

DHHS has accelerated developmentl work on North Carolia Families Accessing Services through Technolgoy, a Web-based eligibility simplification and electronic eligibility determination system for 13 different income-related programs and services.....

As North Carolina's population grows (NC is projected to be the seventh most populous state by 2030) and becomes older as the baby boomer generation ages, the cost of sustaining the Medicaid program will exceed the state's ability to pay for the program....

To mention a few improvements, the DHHS and its Division of Meidcal Assistance will evaluate the option of establishing a 'basic health plan' to assist persons likely to otherwise switch back and forth between the exchange and Medicaid coverage...."

Also in the issue of this good public health journal is the following information re: "Implementation of the Affordable Care Act":

".......One of the primary reasons for passingthe ACA was to make health insurance more accessible and affordable. In NC, approximately 1.7 million nonelderly people (20.4% of the nonelderly population) were uninsured in 2009.....

.....for a family of 4, the limit (of 138%, by 2014) is equivalent to an annual household income of $30,429..."