HEALTHCARE CRISIS!!!

I have been wanting to write a book about my experience as a healthcare provider for sometime now, about 3 years to be precise. As a healthcare provider, RN, to be clear, I have worked in several capacities over a 22 year span, including, certified nursing assistant, phlebotomist, followed as an RN when I completed nursing school in 2000 and passed the NCLEX exam, on my first try, in January 2001, followed further still as surgical/vascular trauma nurse, case manager, utilization review nurse, public health nurse, clinical quality auditor, and lastly, a home health nurse. Throughout my career, I would periodically gauge peoples understanding and perception of the current condition of healthcare in America today by asking patients and/or members to comment on their experience as consumers. Often times, many would agree that healthcare, in general, was and is, in crisis; however, of the people that I further probed for understanding, many could not identify specifically the cause of their sub-par experiences. Consumers would elaborate on their personal experience and discontent with whatever stood out most clearly in their recent memory, however, to put their “finger” on the problem/s, most could not verbalize procedural lapses in care.

Corporately, Americans agree that healthcare is in crisis. But why? How can Americans, who live in the greatest nation in the world, with the greatest advancements in medicine and technology, be so discontented with their healthcare experiences to the degree that the federal government have to devise a star rating system based upon customer satisfaction which classifies, or rather, stratifies healthcare plans into categories, 1–5 star rating that consequently, sometimes adversely, effects their reimbursement rates. Leadership in the managed-care realm agree that the Center for Medicare/Medicaid Services has created a Darwinian environment where health plans performing below the 3.5 rating are struggling to compete with top contenders such as Kaiser Permenente, the only five star health plan in the nation. As a result of the seemingly thriving evolution of Medicare Senior Health Plans, many health insurance companies have spawned solely to attend to consumers eligible for Medicare benefits leaving the legally convoluted realm of commercial health insurance. This is not limited to health plans, but now, involves home healthcare, dialysis centers, which almost strictly involves Medicare members, board-n-care homes, pharmaceutical companies, durable medical equipment companies, and less recently, skilled nursing facilities. Everyone wants a piece of Medicare action; why, because they reimburse first, then ask questions later.

Have you noticed the explosion in the number of home health agencies? Dialysis Centers? In regards to dialysis centers, we could agree that Diabetes Mellitus (DM) has a huge impact on the amount of dialysis centers spawning up on every corner in urban settings, however, the dialysis conglomerates have recognized the profitability margins of being first to open up a center on every block while charging what ever they wish for a bottle of Epogen, usually about $2500/10 ml, that is very expensive. Doctors will never be sure how much is needed to raise a patient’s hematocrit/hemoglobin, so expenditures for this medication can well exceed $100k per month per patient. Recently, a California proposition (Prop 8) was proposed to provide payment capitation to reduce the cost of dialysis. The proposition was defeated by popular vote. DaVita and US Renal Care’s scare tactic commercials had a great effect on Californians, enough so to concern residents that End-Stage Renal Disease (ESRD) patients would not receive the care they needed. Consequently, DaVita and US Renal Care can continue charging Medicare/Medicaid whatever they wish and the same people who voted against capitation of costs, they will continue paying the escalated social/medical benefits. I attribute the failure to pass the proposition to popular ignorance and successful scare, creative campaigns. I became an Clinical Quality Auditor for DaVita Medical Group after they acquired HealthCare Partners, the largest medical group in the country. I will disclose the results of my audit in a later blog… Be sure to stay tuned.

Whether your a member of a health plan, waiting for an answer to a request from your physician for surgery, MRI, or physical therapy (PT), or a patient discharging from an acute care setting to mom & pop home health agency, my ultimate goal for this blog is not only to expose health plans, home health agencies, dialysis centers, drug prices, durable medical equipment, In-Home Support Services, and, hospitals, specifically discharge coordinators, but also to teach the healthcare consumer what to expect from the care they receive from prospective agencies and how to deal with disparities in care. In my twenty plus year career, I have identified processes that not only do not sit well with me as a provider of healthcare services, but also, is seriously disturbing to the consumer expecting quality care.

In my experience, I have identified that healthcare agencies and providers may agree to an objective and indistinguishable definition of what qualifies as quality care, however, despite general consensus on prerequisites for quality care, many healthcare providers experience personal limitations, such as emotional, physical, or psychological barriers that affect their ability to provide quality care. Americans are an ethnically mixed people, culture, traditions, and customs have a direct impact on delivery of care sometimes limiting essential components of quality care, not only with communication/language barriers, but also, disparities may rise from motives to become a healthcare provider; namely, job security and salary. Back in the early, nostalgic days of nursing, women/men became nurses to help people, to make a difference in peoples lives. More recently, the incentive to become a nurse has changed from emotional commitment to make a difference to a fiscal incentive to pursue a nursing career. Why does this matter? It matters because of a phenomena know as “burn out.” Studies show that burn out is manifested in nurses’ attitudes towards the patients they are providing care for. Attitudes of indifference, apathy, harshness, rudeness, and even, hostility have been exhibited by nurses who became burned out and tired of patient care. Where do these nurses end up? They end up working in managed care utilization managers, case managers, or pursue higher levels of education such as Master’s in Business Administration, which is not bad in and of itself, but the vacancy of a nurse that does not want to do bed side care leaves a void in care to be filled by someone with usually with less experience.

My personal motivation for becoming an healthcare provider was a result of emotional, physical, and sexual abuse I endured as a child, however, I did not understand this completely until I became an adult and dealt with the most sincere issues troubling my heart which consequently affected my life and my relationships. Abuse, in its many forms, was brought upon me not only by my father in whose presence I had horrendous accidents such as a baseball injury which left me blind in my left eye at four years old, but also, my mother who emotionally abused me as well as my stepfather who had physically abused me. The sexual abuse was the result of molestation by a the step daughter of my uncle, my older female cousin by marriage, and a older teenager who raped me at about four or five years old.

As a result of the losses I endured as a child, I developed an array of psychological disturbances. My mother gave birth to me when she was still in high school. My parents married when my mother was seventeen and father was twenty years old. My father, according to my mother’s accounts, was an alcoholic. He would drink every weekend while performing with his band. My father was a musician and put his music first before his newly acquired family. He was born into a large Mexican family of ten brothers and sisters. He was the middle child. My mother quickly grew weary of their relationship and divorced him after two years of marriage in 1976 at the age of 19 years old. Unfortunately for the both of us, she continued to live with him even after they divorced. It was at this time that my mother and I had begun to experience the abuse that we would have to endure for the next two years. My father would abuse me to revenge my mother. Looking back, I believe my father was jealous of my mother’s love for me, however, even in my earliest memories, I could remember my mother treating me as a nuisance, the child of a love lost and a responsibility she would have to bear. She grew apathetic and unaffectionate towards me. It was my grandmother who raised me during those early years. She worked as a seamstress, and so, often times, I was left with babysitters who were too young to care for me. It was at this time that I would wonder the streets of El Monte, California as a four-year-old kid on my bike by myself and was raped by an elder teen in the neighborhood. As I grew older, I learned that it was at this time in my life that I lost trust in the people who were supposed to be dearest to me, my family.

I had experienced many traumatic events in my life before I hit my teenage years, consequently, I acquired tons of emotion turmoil which I was not equipped to deal with. What made it worse was looking into to the mirror and seeing a disfigured face looking back at me. I hated the way I looked, and I hated myself for all the bad that I had experienced. Each year in the year books, I would scratch my face from the picture. I was severely troubled. The negativity was compounded by bad advice coming from my own family after my stepfather had passed away. Many times, I had heard, “You’re the man of the house now,” and, “don’t show your weakness by crying.” This was the advice coming from the men in my family, mainly, my uncles and friends of my stepfather. Subsequently, I learned to suppress my feelings understanding that I was not allowed to publicly display any emotion. As difficult as it is to keep a bubble from rising in the water, I could not contain my emotions without the use of chemical substances.

At twelve years old, my stepfather, who I believed loved me as his own, died in a horrific motorcycle accident. This was a very traumatic experience for my mother who had a two-year-old child and myself. Following his funeral, my mother had dove deeply into drugs. She had lost the only man she states she truly ever loved. It was at this time that I had discovered drugs. My stepfather was a pothead and he grew lots of pot up in the canyon of Sierra Madre. When he passed away in February of 1987, he left multiple Ball glass jars full of pot in my mother’s closet. Naturally, as a curious kid who desired the freedoms of adulthood, I began smoking the pot, first for experimentation, followed by a means of escape from my emotions, and later yet, an escape from my reality. I was thirteen years of age. By fifteen, I began to “experiment” with many heavier drugs. I was smoking PCP. I had taken multiple doses of LSD, and it was at this time that I was introduced to cocaine both snorting and smoking the compound. It was at this time that my addiction grew very dark.

To be continued…

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