From Critical Condition: How Health Care in America Became Big Business and Bad Medicine -- Anatomy of a Systems Failure

Donald L. Barlett, James B. Steele

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In This Article

Meltdown

Nowhere was the situation more out of control than at the Artesia clinic in southern Los Angeles County. In March, a patient who had been diagnosed with a kidney stone endured a prolonged and unnecessary delay. Dr. Ernesto Cortez had referred the patient to a KPC-contracted urologist. When the patient arrived for the appointment, he was told the urologist was no longer seeing KPC patients. Not to worry. Dr. Cortez asked the KPC referral department for another specialist. The news was not good. In an area with scores of urologists, there was not one who would take a KPC patient. The best they could do was send him to a specialist in Burbank--a sixty-mile round-trip.

The clinic's resident obstetrical ultrasound technician resigned in July. "She had been with the clinic for over ten years, had special training and skill in evaluating pregnancies, and excelled in detecting fetal abnormalities," according to Dr. Eric Kaplan, chairman of the obstetrics- gynecology department for the Artesia--Long Beach area. She was replaced by technicians from a temp service. Within two months, even that arrangement stopped. The service wasn't being paid. Left with no alternative, Dr. Kaplan said, the doctors began relying on technicians from the clinic's radiology department "who had no particular training or skills in obstetrical ultrasounds."

Because of inexperience, one technician failed to detect early in a pregnancy a case of anencephaly, a condition in which the skull, scalp, and part of the brain are missing. Although some babies may survive for a short time, the condition is always fatal. It wasn't until sixteen weeks into the pregnancy that the birth defect was detected. "Pregnancy termination at sixteen weeks is a prolonged and painful procedure," said Dr. Kaplan, "and is riskier than the short and relatively painless procedure which could have been done at twelve weeks."

Since KPC wasn't paying the Artesia clinic's bills, suppliers refused to deliver certain medications, such as those needed to treat fibroid tumors of the uterus and endometriosis, both painful and potentially serious conditions. They also stopped shipment of mechanical devices used in cases of uterine and vaginal prolapse. On April 17, a desperate e-mail went out from a clinic staff member to a supervisor: "Artesia will be out of chemicals to process films by noon today, [mammogram] is already out and is sharing the main processor, which will not last through mid day. Patients are being rescheduled now."

The company that furnished lab coats for the staff repossessed them during office hours, while doctors were seeing patients. As Dr. Kaplan recalled: "I was approached by a vendor representative in the clinic hallway, in the presence of clinic patients, and was told to surrender my lab coats. I literally had to take my lab coat off of my back."

As the year wore on, even the most basic services collapsed. By July 2000, according to Dr. Angelyn Moultrie-Lizana, an osteopathic physician, "trash in offices and exam rooms was overflowing. Outside the clinic, trash accumulated in the shrubbery." The air-conditioning in her first-floor suite stopped working. When KPC made it clear the air-conditioning would not be fixed, she moved her offices to the second floor.

In August, Dr. Moultrie-Lizana was treating a breast cancer patient who had undergone multiple surgeries for removal of the cancer and reconstruction. Her oncologist wanted a bone scan to determine if the cancer had spread. Dr. Moultrie-Lizana secured a referral and advised the patient to contact her if she did not receive the paperwork in ten days. In mid-September, the patient called back, seeking a referral to another clinic. The Artesia clinic had been out of certain chemicals to conduct a bone scan for at least a month. "There is no telling what effect the month's delay in assessing any spread of her cancer may have on this patient's prognosis and life expectancy," said Dr. Moultrie-Lizana.

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