Archive for December 23rd, 2016

You’d think that Adventist Health, you know that religious, hospital/healthcare corporation would do everything in their power to ensure that their employees who suffered a work-related injury would get care in a timely fashion. Unfortunately, that’s not been my experience, especially with what should’ve been my final surgery.

As I posted yesterday, I suffered a full respiratory/cardiac arrest just as the anesthesiologist gave me a nerve block. More than four months later, I’m still waiting for the follow-up care required after such a life-threatening event; but this delay shouldn’t come as a surprise since Adventist Health did nothing to get the medical clearances needed for my shoulder surgery.

After having to go to court to get the Adventist Health to approve my right shoulder surgery, I discovered that Ms. CA decided that before giving the surgeon the go ahead she had to run it by utilization review (UR), in case UR paper-pushers could find a “way-out” of having to provide the very surgery that Adventist Health had agreed in court to provide, I guess. UR, however, green lighted the surgery, including the hematology consult requested by the surgeon. So after this unseen delay, it fell to my daughter and I to make all the necessary appointments to get the requisite medical clearances.

Medical clearances are part in parcel prior to surgery and this is a generally accepted medical practice and standard of care Ah, but not so with Adventist Health. After scheduling the same hematologist that Adventist Health had used for an earlier clearance, I learned one day before my appointment that Ms. CA had denied the clearance. Not only did she deny the approval she told the hematologist’s assistant that my right shoulders wasn’t part of my Workers’ Compensation claim. So with the clock ticking and thanks to the help of Keck-USC where the hematologist practiced we were able to get my private healthcare insurance to cover the consult. Of course the whole point behind Workers’ Compensation is that your employer’s workers’ compensation insurance pays for all the care, direct and related, of the injured worker. Perhaps this isn’t the case with Adventist Health?

To be continued . . .

You’d think that if you surfer a life threatening emergency while undergoing a surgical procedure you’d think that your employer’s Workers’ Compensation insurer carrier wouldn’t question your surgeon’s medical decision – but that didn’t happen in my life-threatening moment. Here’s what happened.

After several years of going back and forth with Adventist Health (who’s self-insured) to get them to approve surgery on my right shoulder I finally got the green light. This process had been very contentious and time consuming, but on August 17th, I arrived at the “hospital” to have my surgery. All was going along as planned until just after the anesthesiologist performed a nerve block. I almost immediately began to experience problems breathing and informed the operating team that I was having severe chest pains and couldn’t breathe. And as they say “all hell broke loose”. I remember the anesthesiologist screaming “I need help over here” and I asked God to please let me live.

I awoke sometime later in the ICU, hooked up to a BPAP and other various monitors and medical personnel. It was then that I learned that not only had I suffered respiratory arrest but a cardiac arrest as well – in short I “died” on the table. After a little more than a day in the ICU, I was discharged home. Not long afterwards I received a letter from Excel Utilization Review (UR), the UR company that my Adventist Health claims adjuster, who shall remain “nameless to protect the guilty” so I’ll just call her Ms. CA. Apparently she thought that my surgeon’s decision to have me admitted to ICU after such a serious medical event required a review and approval of Excel, you know just in case it was an inappropriate and costly decision to admit a patient who’d suffered a full respiratory and cardiac event to ICU. Yeah, you read that right, Adventist Health, a hospital/healthcare corporation, was unsure that my surgeon had made a medically sound and financially correct decision!

Excel denied my admission to ICU! However, in their defense one of the reasons was the failure of my surgeon to send them “appropriate” information, but as a medical professional myself I was rather incredulous that they (Adventist Health and Excel) even questioned the need to admit a patient to ICU – most surgeons don’t just do this on a whim. But this is Workers’ Compensation after all so logic goes out the window and often doesn’t seem to apply.

Sometime later I received another letter from Excel that approved my ICU stay – whew! The irony was that Excel actually commented that the average ICU stays in a case such as mine was just less than 5 days, while I stayed just over 1 day. So while Ms. CA thought my stay was possibly inappropriate and costing Adventist Health unnecessary money that turned out not to be the case.

In the meantime, Ms. CA refused to return me to “total temporary disability” (TTD) status as order by my surgeon and have taken no action to discover what might have happened to cause this serious medical event.

Stay tunned for more . . . .