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Tucson Weekly Murder By HMO

Shouldn't the Second Amendment and the right of self-defense cover this situation?

By Jeff Smith

APRIL 13, 1998:  By now probably you've seen As Good As It Gets. By now probably you have been to the doctor, been told your problem is not up his alley and that you need a proctologist to have a look at whatever is up your alley. By now probably you have been around the dance floor a few twirls with two different sets of office help with Dr. A, Dr. Z, and a third from the HMO that runs them both.

By now probably you have heard Helen Hunt's line from the aforementioned movie, anent the aforementioned medical scenario and the aforementioned clerical gauntlet, and cheered lustily with the rest of the folks in the darkened theater, most of whom probably have come to despise health maintenance organizations more than they formerly despised the Department of Motor Vehicles.

Welcome to the Diffident New World.

I had forgotten the precise phraseology Ms. Hunt's character used to excoriate these beasts of bureaucracy, but fortunately Ellen Goodman takes copious notes and has been moved by her muse to write not one but two columns on the hot topic of the moment. Ms. Goodman is a nationally syndicated writer who appears in the morning daily (which, incidentally, was recently rumored about to be bought by the Gannett Corp., which would ultimately reduce the number of daily newspapers in Tucson to one, with the inevitable, eventual languishment and death of the Citizen; and then to zero, as Gannett does what it inevitably, eventually does to all its papers, and that is: milk the cash-cow white and reduce it to a thin wrapper for a regional edition of USA Today. The Star, of course, denies the rumors.)

But I digress.

Ellen Goodman. Yes. In deference to her retail outlets and to the delicate sensibilities of the editors and readers, Ms. Goodman quotes Hunt thusly:

"...f****** HMO b****** pieces of s***!"

Allow me to translate to the Weekly reader: (Para servirle en Espanol, marque el uno.)

Bueno, dice "!Chingados HMO cabrones pedazos de caca!"

En Ingles:

"Fucking HMO bastard pieces of shit!"

There, that wasn't so hard now, was it?

Of course Hunt, while she probably has dealt with tediously slow bureaucracies, and Ellen Goodman, ibid., and most of the theater and newspaper audience, op cit., most likely never have had their lives threatened by this, albeit annoying, nonetheless merely inconvenient verity.

I, on the other hand, risk my life every time I make an appointment with the doctor. A case in point. The instant case, in fact.

I'm a gimp, a paraplegic, wheelchair-bound. Lost communication with my southern latitudes years ago. As an occupational hazard of this state, I am susceptible to infections of the urinary tract, and as such I often have to take antibiotics. After a while the bad bugs which have colonized my antipodes get smart, like cucarachas, and learn to thrive on the poisons I send their way. A few weeks ago one of the little cups of cider I sent off to the lab came back saying pseudomonas, a very nasty little bug that requires intravenous antibiotics twice daily, 45 minutes per session, for 14 days, to murder off. Serious shit.

So my hometown doc, a fine man, a friend and no way a villain of this piece, calls me as soon as he can, to come in for a chat as soon as I can, and I show up after a sleepless night imagining I'm about to hear the ultimate medical good news/bad news joke ("The bad news is you're going to die; the good news is I'm sleeping with that gorgeous nurse who just took your urine specimen"), only to be told we ought to check with a urologist first, in case they've invented something easier than two weeks with a faucet in your arm.

As you may imagine, the merry-go-round broke down.

Receptionist A calls Receptionist B, says Smith needs to see Dr. B on Dr. A's orders ASAP, and is given a date 18 days later. Smith says no good, calls Dr. B at home on Sunday night and is told to fax the lab reports to him first thing Monday morning. Then Dr. B gets sick, is out of the office, cut to the chase, Smith doesn't get to see Dr. B until the following Friday, involving 120 miles of driving, and an extemporaneous lecture by insurance clerk B over not having brought the proper referral forms for the HMO. Smith later talks to insurance clerk A, who says the referral was given over the phone. Smith calls back to B, who says, "uh-uh," back to A, who says, "uh-HUH?"...and so forth.

Meanwhile Dr. B looks at some fresh pee, says it doesn't look bad. Smith says send to the lab anyway, OK? This is Friday, lab report isn't back till Tuesday, confirms bad bug. Office B says it faxed all this info, plus suggested further tests (requiring out-patient hospital visit) to Office A. Office A, as of Wednesday, says it has received nothing.

It is now Wednesday afternoon, and I have been feeling positively wretched for the last five days; only intermittently wretched for the previous month. I have no idea when these two offices, insurance clerks, doctors will get in personal, telephonic, written or digital communication regarding my state of health, let alone when the fourth major party to the medical team--whichever hospital/lab in Nogales or Tucson will perform whatever tests--and when those tests will be scheduled. If tradition holds, it could be a month from now.

If my personal history repeats itself, I could be dead, buried, mourned, gotten over, probated and forgotten by then. Nine years ago a similar sort of problem resulted in two cerebral hemorrhages which, statistically, are fatal on the spot in 50 percent of first occurrences, and about 84 percent of second hits. I was hospitalized for a week with the first, was discharged and had the second within 24 hours. Suffice it to say the hospital staff tread lightly around me the second time, until I assured them I am not a litigious sort.

But I am getting a trifle anxious.

Could you f****** HMO b****** pieces of s*** simply pick up the phone and tell the appropriate parties to just do it? I've got a dog, a horse, a burro and six cats to feed.

Oh, and remember what I said about risking my life every time I make a medical appointment? I contrived a way around that. Down here in rustic Begonia, whenever I think I've got something wonky, I just roll on into the clinic, say Howdy to Bernie, ask Linda for a cup, pee in it, and ask Carlos to call Walgreen's with a scrip for whatever I need.

They're wonderful about it and I get fast, efficient, friendly service. The only time I have trouble is when I make the mistake of playing by the rules, and getting more than one set of medical professionals involved.

Then I might as well be dead: They certainly have a way of making you wish it.

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