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My Contribution November 2004
Striking a Blow Against an HMO Past Issues
Her friends told her that Kaiser Permanente, one of the nation's largest health maintenance organizations, was too big to fight. Her lawyer warned her it would be a hard case to make. Others told her to get on with her life.
But California member Mary-Edith Blum refused to accept the substandard care she felt she received by her HMO. So Blum sued Kaiser under California law for "elder abuse," and last year, after a four-day arbitration, she won the case and was awarded $100,000.
Blum not only won a large sum of money in the settlement that day, though—she also won a battle for seniors who are misunderstood or mistreated by hospitals and medical personnel due to their age. "Because I was 83, they act like you're on your way out," Blum says. "I didn't really want to get involved in a lawsuit, but I finally said...somebody's got to speak up."
Blum's problems with West Anaheim Medical Center started after a major surgery and got worse when she was discharged over her protests from the hospital just 11 days later, without any explanation or prior notice. She was sent to a nursing home where she endured nearly a month of poor treatment until she was sent home.
"I couldn't get out of bed alone, I couldn't stand alone, but they sent me home," Blum said. "And it was miserable [at the nursing home]; you'd have to wet the bed because they wouldn't come around for an hour and 40 minutes" to assist with getting to the lavatory. "And then they'd say you were drinking too much water. Twice I was told, ‘Well, this isn't the Hilton.'"
After being discharged from the nursing home, Blum wrote letters to Kaiser describing the specific problems she had with her care and treatment at the hospital and nursing home. Getting no response, Blum hired attorney Susan Mogilka. "My allegation was that the full scope of care was not given because of her [Blum's] age," Mogilka says. "This is the first case I had where the elder herself was really coherent enough to report her own abuse. The arbitrator was also very impressed with her ability to speak for herself."
After four days listening to testimony and examining other evidence, the arbitrator concluded that although Blum had been given appropriate medical care by the hospital and nursing home staff, her emotional needs had not been met.
Medical providers "simply did what needed to be done from a medical standpoint and totally ignored her emotional needs," the arbitrator's report states. For example, the report documented instances in which Blum was put through extensive testing by the hospital staff without being told the purpose or results of the tests, and it noted that the nursing home staff was, at times, confrontational and indifferent to her concerns.
Although she still suffers emotional scars from the experience, Blum is now in much better health—living on her own, driving herself around, and swimming regularly for therapy. "It's a very educational thing to go through," Blum said. "I've lived through it all by prayer and by having good health to begin with."
Have a problem with your health care or need legal advice? The national network of Area Agencies on Aging (AAoA) may be able to help you. Many local programs offer health insurance counseling and legal advice, in addition to the more widely known services such as Meals on Wheels. To find an agency in your area, contact Eldercare Locator at 800-677-1116.
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