Published: May 19, 2003, 06:59:41 AM PDT

Originally posted at: http://www.modbee.com/local/story/6788121p-7726777c.html 
Fannie Rogers spent the last weeks of her life suffering. Her family and friends blame Kaiser Permanente and what they see as a breakdown in the health system.

In late March, a doctor was trying to schedule the 86-year-old Modesto woman for surgery at Memorial Medical Center to relieve blockage in a leg artery. Then the hospital's contract with Kaiser expired April 1, and she had to start over.

The next closest specialist and hospital that could treat her was in Stockton, 32 miles away.

The blockage turned the foot black and caused her constant pain, family members said. Her daughter spent weeks trying to schedule appointments before Rogers died of cardiac arrest April 29.

"I had talked to her one time on the telephone and she was in so much pain I could hardly understand her," friend Linda Hobson said.

Kaiser spokesman David DeButts said the organization can't comment on Rogers' case because of federal patient confidentiality rules. Other providers involved also declined to talk.

Kaiser officials say patients have been getting proper care since the organization parted ways with Memorial. But the revised network has come under fire from Kaiser members.

Hobson befriended Rogers several years ago, on bus rides to the Chicken Ranch Bingo & Casino in Jamestown. Rogers, a food-processing worker before she retired, was so lucky at bingo she once won a car and later enough cash to buy a Chrysler Imperial. She was able to drive the car until last year.

"From what I was told, it was horrible," Hobson said of her friend's final days. "They were shuttling her around and giving her the run-around, when they should have taken care of it."

Nearly 90,000 patients affected

For six years, Memorial was the primary hospital for Kaiser members in Stanislaus County, who now number more than 89,500.

Since April 1, Kaiser patients have been forced to go to Turlock, Stockton or Sacramento for most hospital care. Many also go out of town for speciality care because few Modesto specialists have admitting rights at Turlock's Emanuel Medical Center or Stockton's Dameron Hospital.

June Verissimo, Rogers' daughter, said it took almost four weeks for a new set of doctors to get her mother ready for surgery in Stockton.

Despite circulation and kidney problems, Rogers' family believed the operation would save the leg and give her several more good years.

If authorized at Memorial, the bypass surgery would have been done the first week in April, Rogers' family said.

When that operation was canceled, her surgeon tried to schedule the operation for Modesto's Stanislaus Surgical Hospital, but was denied because it does not have an intensive care unit.

"It's a fairly complex vascular problem," said Mike Lipomi, the hospital's chief executive officer. Often, patients with that condition also suffer from coronary artery disease and might need advanced post-operative service, he said.

Two weeks elapsed before a Stockton cardiologist gave her a stress test. Another test was set for April 25, but by that time, Rogers' pain was becoming unbearable.

"Her feeling was, 'Why do I have to go through all this pain?'" said her son, Paul Correll. "That was her comment exactly."

On April 23, the family took her to the Memorial emergency room.

Verissimo and Correll said doctors and emergency room personnel at Memorial were outraged at the condition of the foot and wanted to treat Rogers. Kaiser denied permission, the family said.

"The Kaiser doctor told me to take her to the Dameron ER in Stockton, and she made out a prescription for morphine pills," Verissimo said. "I was livid. We almost took her, but she had been in the emergency room all day, she hadn't eaten and she had dialysis the next day."

The medication improved Rogers' spirits, and she went to dialysis the next day in Modesto, her daughter said.

When her Stockton doctors did an angiogram April 25, they found that she had a heart problem, and she was admitted to Dameron the next day. Verissimo was in her mother's hospital room when Rogers' blood pressure plummeted and nurses rushed in to revive her. She died of heart failure two days later.

Greg Monta, a social worker at the center where Rogers received dialysis, said he believes the health system failed in this case.

"She was engaged in life, interacted with staff, family and friends, was a pleasant individual and happy to be alive," he said. "She changed to someone whose life ended in a great deal of pain, with not a lot of hope provided to her and her family."

Kaiser's DeButts said the 10,300 county members of the organization's health maintenance organization for seniors, the program Rogers was in, are being served.

"Kaiser members are receiving appropriate care for their conditions," he said. "They are followed closely by their physicians, and there are case managers who provide referrals as well as services and support that our members need."

Kaiser says it's investing $428 million in a new medical campus in Modesto, including a 200-bed hospital slated to open in five years.

A Dale Road office will open in June with orthopedics, occupational medicine, neurology, dermatology and other services.

But some Kaiser members have said a better interim network should have been in place when the Memorial contract expired.

Coordinators at Stanislaus County's Area Agency on Aging said they have received 30 to 40 calls from seniors concerned about the Kaiser-Memorial split and about seeing specialists.

Amy Dixon, Area Agency on Aging coordinator who works part time in Memorial's admissions office and at Emanuel, said: "We found out Emanuel doesn't have a neurologist or orthopedic doctor available. For those specialties they need to go to Stockton or Sacramento."

Often, the agency refers people who need rides to medical appointments to Catholic Charities' free service, but it operates only in Stanislaus County.

State has received a few complaints

The state Department of Managed Health Care has received 54 complaints about the Kaiser-Memorial split, although it's not known how many from seniors. Ten were detailed complaints that led to investigations, and most of the issues were resolved, said Deputy Director Steve Fisher.

Earlier this year, the department reviewed Kaiser's revised plan for serving Stanislaus County and found that it complied with state law, though Fisher said the law needs to be strengthened to protect patients when hospitals and HMOs sever ties.

He said the law lets patients stay with their providers for up to 90 days if they have acute conditions or serious chronic conditions.

That law does not apply to Medicare patients because a successful HMO-industry lawsuit established that many state protections don't apply to those patients, Fisher said.

Verissimo said friends have encouraged her to seek legal advice, but she isn't sure.

"Right now, I have to take care of my grieving family and I have to take care of myself, and I don't know how I am going to deal with this," she said.

Catholic Charities offers wheelchair accessible transportation to the doctor's office, grocery store, Social Security, banks and other places in Stanislaus County, Monday through Friday. Call one week in advance, 529-3784.

People who have problems with an HMO can call the state Department of Managed Health Care at (888) HMO-2219.

Bee staff writer Ken Carlson can be reached at 578-2321 or kcarlson@modbee.com.